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. 2002 Dec;87(6):511–517. doi: 10.1136/adc.87.6.511

Outcome of reaching end stage renal failure in children under 2 years of age

M Coulthard 1, J Crosier 1
PMCID: PMC1755807  PMID: 12456551

Abstract

Aims: To determine the outcome of children who reach end stage renal failure before the age of 2 years.

Methods: Using a retrospective questionnaire, 10 years' data were collected from the paediatric nephrology units in Britain and Ireland (1988 to 1997, follow up 1.3–11.5 years).

Results: A total of 192 children were identified; 0.31/million/year. Most had congenital or inherited conditions, and there were more boys. Latterly, half were diagnosed antenatally. Ninety per cent were dialysed initially, most using home peritoneal cyclers, some by haemodialysis through central lines. Five per cent recovered sufficient function to come off dialysis. Most required tube feeding (often gastrostomy) and erythropoietin; some needed growth hormone. A total of 56% received a transplant (2% without prior dialysis) at (medians) 2.6 years and 12.3 kg. The 2 and 10 year survival of first kidneys was 78%. Growth improved following transplantation. Fourteen per cent died because treatment was not started or was withdrawn. Most had particularly complex renal conditions, or additional major non-renal diagnoses. Typically, decisions not to treat were made mutually between clinicians and families. When treatment was continued, 71% survived, and few had serious non-renal conditions. Most attended normal schools, and by 6 years of age, less than 10% still required dialysis. Infants starting treatment under and over 1 month of age fared equally well.

Conclusions: By school age, most infants treated for end stage renal failure will have a functioning transplant, reasonable growth, and will attend a normal class, regardless of the age at which they commence treatment. Treatment is seldom sustained in children who have serious additional medical conditions. It is reasonable to treat infants with uncomplicated renal failure.

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Figure 1 .

Figure 1

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The outcome of 192 children who reached end stage renal failure under the age of 2 in the UK. In the bottom line the figures in plain boxes represent live children, and those in shaded boxes children that have died.

Figure 2 .

Figure 2

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Kaplan-Meier plot of children who reached end stage renal failure before the age of 2, showing the age at which the transplanted children received their first graft. The numbers of cases available for analysis are indicated by the vertical bars and numbers.

Figure 3 .

Figure 3

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Patient and kidney survival curves after the first graft into 107 chilren who reached end stage renal failure before the age of 2. The numbers of cases available for analysis are indicated by the vertical bars.

Figure 4 .

Figure 4

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The most recent height and weight values for 63 boys and 23 girls who currently have a functioning transplant, compared to the normal 2nd, 50th, and 98th centiles.

Figure 5 .

Figure 5

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Survival curves for children who reached end stage renal failure before the age of 2, and died (a) because treatment was not started, (b) because treatment was withdrawn, or (c) despite remaining on dialysis.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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