Health >> JAMA Current Issue

Improving Quality of Care and Outcomes for Pediatric Patients With End-stage Kidney Disease

Link [2022-08-03 09:14:54]

Childhood end-stage kidney disease (ESKD) is rare, accounting for approximately 1% of individuals with ESKD in the US. Unique features that distinguish pediatric from adult ESKD include frequent concomitant congenital anomalies, detrimental effects on all aspects of growth and development, and the need for decades of kidney replacement therapy. The beneficial effects of transplants in pediatric patients are clear. Compared with pediatric patients treated with dialysis, those who receive a transplant demonstrate better growth, neurocognitive development, academic performance, and quality of life. In a recent US Renal Data System (USRDS) 30-year cohort study involving 28 337 pediatric patients who initiated kidney replacement therapy before they were 18 years old, receipt of a transplant was associated with a decreased risk of all-cause death in time-varying analyses (adjusted hazard ratio [HR], 0.28; 95% CI, 0.16-0.48). Furthermore, excess mortality from ESKD has decreased markedly over decades, with the largest relative improvements seen in the youngest persons (0-14 years) with a functioning transplant. Accordingly, pediatric patients with ESKD are nearly universally referred for transplants.