Initiation of dialysis at a higher level of renal function related to lower patient survival

A recent badysis of US data over two decades indicates that children with kidney failure begin to be dialysed to higher levels of kidney function. Initiation of dialysis at a higher level of renal function, however, was related to a lower survival of the patient. The results, which will appear in a future issue of JASN, suggest that asymptomatic children with kidney failure could benefit from a delay in dialysis.

The optimal treatment for children with chronic kidney failure is kidney transplantation, but most children are treated with dialysis before being transplanted from the kidney for a variety of reasons, including to treat problems with kidney disease. electrolytes, eliminate excess fluid in the body and reduce excessive fatigue. It is not clear, however, whether the timing of initiating dialysis affects the long-term health of patients.

To investigate, a team led by Elaine Ku, MD, MAS and Erica Winnicki, MD (University of California at San Francisco) badyzed information about children who started dialysis in the United States between 1995 and 2015. The researchers examined the kidney level of patients function at the time of initiation of dialysis; they defined upper renal function as an estimated glomerular filtration rate greater than 10 ml / min / 1.73 m² and renal function less than 10 ml / min / 1.73 m² or lower. (Renal failure is defined as an estimated glomerular filtration rate of less than 15 ml / min / 1.73 m²).

Of the 15,170 children, 4327 (29%) had superior renal function at the beginning of dialysis. The risk of death was 1.36 times higher in children with high renal function at the beginning of dialysis. The risk of death was even greater in children with high renal function who had started on hemodialysis rather than peritoneal dialysis.

We also found that over a 20-year period, children are put on dialysis with higher kidney function. Understanding why children start dialysis with high kidney function is important, as concerted efforts to delay dialysis initiation in asymptomatic children could potentially be a means of improving survival, based on these observations. In addition, delaying the initiation of dialysis may leave more time for living donors to review kidney transplantation and shorten the time that children should spend on dialysis. "

Erica Winnicki, MD, University of California, San Francisco

An accompanying editorial noted that increasing rates of children starting dialysis with an estimated glomerular filtration rate greater than 10 ml / min / 1.73 m² over the last two decades are worrying given the lack of any benefit. "Clinicians, children and their families experience daily direct, immediate and undeniable adverse financial, psychosocial and physical consequences of dialysis," the authors wrote.