A recent analysis of information on children with kidney failure in the
US suggests that the risk of death was higher among the children who began
their dialysis with higher kidney function levels. The data from two decades
also indicated that children with kidney failure are being started on
with higher kidney function. However, it
has been unclear if the long-term health of the children is affected by the
timing of dialysis initiation.
Dr. Elaine Ku
and Dr. Erica Winnicki of the University of California, San Francisco
have led a team that analyzed the data on children from the United States who
began dialysis between 1995 and 2015.
examined the patients' level of kidney function when the dialysis began. Kidney
failure is defined by an estimated glomerular filtration rate (eGFR) below
15 ml/min/1.73m2, and for the research, an estimated glomerular
filtration rate above 10 ml/min/1.73m2 defined higher kidney function and lower
kidney function was 10 ml/min/1.73m2 or lower.
Findings of the
15,170 children whose data were analyzed, 4327 (29%) had higher kidney
function when the dialysis was started. The
risk of death was 1.36 times higher among this group of children. The risk was
even greater for children who were on hemodialysis rather than peritoneal
The findings, which would be published in an upcoming issue of
the Journal of the American Society of Nephrology,
also suggest that delaying dialysis may benefit the
asymptomatic children with kidney failure.
"We also found that over a 20-year period,
children are being started on dialysis with higher kidney function,"
Winnicki. "Understanding why children are
being started on dialysis at higher kidney function is important, as concerted
efforts to delay dialysis initiation in asymptomatic children could potentially
be an avenue for improvement in survival based on these observational findings.
In addition, delaying dialysis initiation could allow for more time for living
donors to undergo workup for kidney transplantation and shorten the time that
children would need to spend on dialysis,"
accompanying editorial, it was noted that despite any evident benefit, children
starting dialysis with an eGFR above 10 ml/min/1.73m2 have been
increasing over the past 2 decades, which is concerning. The
authors have quoted that, "The direct,
immediate, and incontrovertible deleterious financial, psychosocial, and
physical impacts of dialysis are experienced on a daily basis by clinicians,
children, and their families."
- Higher eGFR at Dialysis Initiation Is Not Associated with a Survival Benefit in Children - (https://jasn.asnjournals.org/content/early/2019/07/17/ASN.2018111130)