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.International Pediatric Nephrology Association (IPNA)
International Society for Peritoneal Dialysis (ISPD)
Baxter Healthcare
Fresenius Medical CareVersión publicada - versión final del edito
