ARTERIOVENOUS FISTULAE ARE ASSOCIATED WITH FEWER COMPLICATIONS AND IMPROVED DIALYSIS EFFICACY COMPARED TO CENTRAL VENOUS CATHETERS: FINDINGS FROM THE INTERNATIONAL PEDIATRIC HEMODIALYSIS NETWORK

WOS: 000443998400288

National Health Survey on the Prevalence of Urinary Abnormalities in the Population: then and now (1975 to 2012)

ANNALS ACADEMY OF MEDICINE SINGAPORE418339-346Singapor

Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry

PubMedID: 31010601Rationale & Objective: Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. Study Design: Prospective observational cohort study. Setting & Participants: 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. Predictor: Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. Outcome: Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. Analytical Approach: Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. Results: During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P < 0.001). Limitations: Clinical rather than population-based data. Conclusions: CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices. © 2019 National Kidney Foundation, Inc.Baxter International Iran University of Medical Sciences Uniwersytet Jagiellonski Collegium Medicum Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Seoul National University United Arab Emirates University All-India Institute of Medical Sciences Great Ormond Street Hospital Charity National Rosacea Society Children's Hospital of Philadelphia Ankara University of Minnesota City, University of London: GdanskWe acknowledge the financial support of Baxter Health Care and Fresenius Medical Care. They were not involved in study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication.We thank Mr Rouven Behnisch for support in conducting statistical analyses. The following Principal Investigators are current contributors to the IPHN Registry. Argentina: P.A. Coccia (Hospital Italiano de Buenos Aires), A. Suarez (Hospital de Ninos Sor. Maria Ludovica La Plata), L. Alconcher (Hospital Interzonal General, Bahia Blanca); Canada: E. Harvey (Hospital for Sick Children, Toronto), C. White (BC Children's Hospital, Vancouver); Chile: F. Cano (Hospital Luis Calvo Mackenna, Santiago), M.A. Contreras (Roberto del Rio Hospital, Santiago); China: H. Xu (Children's Hospital of Fudan University, Shanghai); Colombia: J.J. Vanegas (Instituto del Rinon, Medellin), L.M. Higuita (Baxter Servicio al Cliente Colombia, Medellin); Czech Republic: K. Vondrak (University Hospital Motol, Prague); Finland: J. Lauronen (Hospital for Children and Adolescents, Helsinki); France: B. Ranchin (Hôpital Femme Mcre Enfant, Lyon), T. Ulinski (Armand Trousseau Hospital, Paris), S. Krid (Hopital Necker_Enfants Malades, Paris), M. Fischbach (Children's Dialysis Center, Strasbourg), Ch. Samaille (Hospital Jeanne de Frandre, Lille), M. Fila (Pediatric Nephrology Unit, Montpellier); Germany: D. Muller (Charité Virchow-Klinikum, Berlin), S. Habbig (University Hospital, Cologne), R. Büscher (Children's Hospital Essen), C.P. Schmitt (Center for Pediatrics and Adolescent Medicine, Heidelberg); G. Klaus (KfH Kidney Center, Marburg), H. Billing (Children's University Hospital, Tübingen); Greece: C. Stafanidis (A&P Kyriakou Children’s Hospital, Athens); Hungary: A.J. Szabo (Semmelweis University, Budapest); India: A. Bagga (All India Institute of Medical Sciences, New Delhi), B. Basu (NRS Medical College & Hospital, Kolkata), S. Sethi (The Medicity, Gurgaon); Iran: N. Hooman (Iran University of Medical Sciences, Tehran); Italy: E. Verrina (G. Gaslini Institute, Genova), S. Testa (Fondazione Ospedale Maggiore Policlinico, Milano), E. Vidal (Pediatric Nephrology, Dialysis and Transplant Unit, Padova), G. Leozappa (Department of Nefrologia-Urologia, Rome); Israel: D. Landau (Soroka Medical Center, Beer-Sheva); Korea: I.S. Ha (Seoul National University Children's Hospital, Seoul); Macedonia: E. Sahpazova (Pediatric Clinic, Skopje); Malaysia: Y.N. Lim (Kuala Lumpur Hospital, Kuala Lumpur); New Zealand: W. Wong (Starship Children's Hospital, Auckland); Nicaragua: Y. Silva (Hospital Infantil de Nicaragua, Managua); Oman: M. Al Ryami (Royal Hospital, Muscat); Peru: R. Loza Munarriz (Cayetano Heredia Hospital, Lima); Philippines: Z. Antonio (National Kidney and Transplant Institute, Quezon City); Poland: A.M. Zurowska, D. Borzych-Duzalka (Medical University, Gdansk); D. Drozdz (Jagiellonian University Medical College), S. Prokurat (Children's Memorial Health Institute, Warsaw), M. Szczepanska (Dialysis Division for Children, Zabrze); Saudi Arabia: J. Kari (King Abdul Aziz University Hospital, Jeddah); Serbia: D. Kruscic (University Children’s Hospital, Belgrade); Singapore: H.K. Yap (Shaw-NKF-NUH Children's Kidney Center); Spain: G. Ariceta (University Hospital Materno-Infantil Vall d'Hebron, Barcelona); Sweden: L. Swartz (Barnkliniken, Lund); Turkey: A. Bayazit (Cukrova University, Adana), A.S. Bakkaloglu (Hacettepe University, Ankara); S. Bakkaloglu (Gazi University, Ankara), I. Bilge (Department of Pediatric Nephrology, Çapa-Istanbul; Tepecik Children and Research Hospital, Izmir), S. Mir (Ege University Faculty of Medicine, Izmir-Bornova); United Arab Emirates: G. Kumar (Sheikh Khalifa Medical City, Abu Dhabi), L. Eid (Dubai Hospital, Dubai); E. Simkova (Al Jalila Hospital, Dubai); United Kingdom: R. Shroff (Great Ormond Street Hospital, London), C. Ried (Evelina Hospital, London); Uruguay: J. Grünberg (SE.N.NI.AD, Montevideo); United States: H. Patel (Children's Hospital, Columbus), B.A. Warady (Children's Mercy Hospital, Kansas City), M. Rheault (University of Minnesota, Amplatz Children's Hospital, Minneapolis), M. Pradhan (The Children's Hospital of Philadelphia, Philadelphia), J. Flynn (Seattle Children's Hospital, Seattle), C. Wong (Lucile Packard Children’s Hospital, Palo Alto)

Multicenter study on the genetics of glomerular diseases among southeast and south Asians: Deciphering Diversities - Renal Asian Genetics Network (DRAGoN)

10.1111/cge.14116CLINICAL GENETIC

Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric Peritoneal Dialysis Network Registry

Rationale & Objective: Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macroeconomic factors. Study Design: Prospective cohort study. Setting & Participants: Patients younger than 19 years at inclusion into the International Pediatric Peritoneal Dialysis Network registry, who initiated MPD between 1996 and 2017. Exposure: Region as primary exposure (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical, and macroeconomic (4 income groups based on gross national income) factors also were studied. Outcome: All-cause MPD mortality. Analytical Approach: Patients were observed for 3 years, and the mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates. Results: A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After 3 years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%). Limitations: The interpretation of interregional survival differences as found in this study may be hampered by selection bias. Conclusions: This study shows that the overall 3-year patient survival on pediatric MPD is high, and that country income is associated with patient survival