Outcome of Patients Initiating Chronic Peritoneal Dialysis During the First Year of Life

Abstract

BACKGROUND AND OBJECTIVE: Among children with end-stage renal disease (ESRD), those who initiated chronic dialysis during the first year of life historically were less likely to survive or receive a kidney transplant compared with those who initiated dialysis later in childhood. We hypothesized that recently treated infants have experienced improved outcomes. METHODS: We queried the North American Pediatric Renal Trials and Collaborative Studies database, obtaining information on 628 children who initiated maintenance peritoneal dialysis for treatment of ESRD at <1 year of age. We further subcategorized these children by age (neonates, ≤31 days and infants, 32–365 days) and date of dialysis initiation (past, 1992–1999, and recent, 2000–2012). RESULTS: Survival while on dialysis and overall survival were significantly better among neonates and infants in the recent cohort. Overall survival at 3 years after dialysis initiation was 78.6% and 84.6% among the recently treated neonates and infants, respectively. Neonates and infants in the recent cohort also were more likely to terminate dialysis for transplantation, and graft survival was improved among recently transplanted infants (3-year graft survival 92.1%). CONCLUSIONS: Among children who initiate chronic peritoneal dialysis for treatment of ESRD in the first year of life, survival has improved in recent years. Graft survival also has improved for the subset of these patients who received a kidney transplant.