TY  - JOUR
JF  - CKJ: CLINICAL KIDNEY JOURNAL
TI  - Disparities in treatment and outcome of kidney replacement therapy in children with comorbidities: an ESPN/ERA Registry study
UR  - https://doi.org/10.1093/ckj/sfad008
EP  - 755
ID  - publicatio36114
SN  - 2048-8513
A1  -  Schild Raphael
A1  -  Dupont Simeon
A1  -  Harambat Jerome
A1  -  Vidal Enrico
A1  -  Balat Ayse
A1  -  Bereczki Csaba
A1  -  Bienias Beata
A1  -  Brandstrom Per
A1  -  Broux Francoise
A1  -  Consolo Silvia
A1  -  Gojkovic Ivana
A1  -  Groothoff Jaap W.
A1  -  Hommel Kristine
A1  -  Hubmann Holger
A1  -  Braddon Fiona E. M.
A1  -  Pankratenko Tatiana E.
A1  -  Papachristou Fotios
A1  -  Plumb Lucy A.
A1  -  Podracka Ludmila
A1  -  Prokurat Sylwester
A1  -  Bjerre Anna
A1  -  Cordinha Carolina
A1  -  Tainio Juuso
A1  -  Shkurti Enkelejda
A1  -  Sparta Giuseppina
A1  -  Vondrak Karel
A1  -  Jager Kitty J.
A1  -  Oh Jun
A1  -  Bonthuis Marjolein
Y1  - 2023///
SP  - 745
N2  - Background Data on comorbidities in children on kidney replacement therapy (KRT) are scarce. Considering their high relevance for prognosis and treatment, this study aims to analyse the prevalence and implications of comorbidities in European children on KRT. Methods We included data from patients <20 years of age when commencing KRT from 2007 to 2017 from 22 European countries within the European Society of Paediatric Nephrology/European Renal Association Registry. Differences between patients with and without comorbidities in access to kidney transplantation (KT) and patient and graft survival were estimated using Cox regression. Results Comorbidities were present in 33% of the 4127 children commencing KRT and the prevalence has steadily increased by 5% annually since 2007. Comorbidities were most frequent in high-income countries (43% versus 24% in low-income countries and 33% in middle-income countries). Patients with comorbidities had a lower access to transplantation {adjusted hazard ratio [aHR] 0.67 [95% confidence interval (CI) 0.61-0.74]} and a higher risk of death [aHR 1.79 (95% CI 1.38-2.32)]. The increased mortality was only seen in dialysis patients [aHR 1.60 (95% CI 1.21-2.13)], and not after KT. For both outcomes, the impact of comorbidities was stronger in low-income countries. Graft survival was not affected by the presence of comorbidities [aHR for 5-year graft failure 1.18 (95% CI 0.84-1.65)]. Conclusions Comorbidities have become more frequent in children on KRT and reduce their access to transplantation and survival, especially when remaining on dialysis. KT should be considered as an option in all paediatric KRT patients and efforts should be made to identify modifiable barriers to KT for children with comorbidities.Lay Summary Kidney transplantation (KT) is considered the optimal treatment for children who suffer from permanent kidney failure, because it leads to a lower mortality and higher quality of life compared with dialysis. Children on dialysis frequently suffer from diseases of other organs (comorbidities) that can directly lower their life expectancy and could potentially represent a barrier for transplantation, posing an additional disease burden for these children. In this study we looked at data from a large multinational registry for children with kidney failure who require kidney replacement. Using these data, we studied whether these children suffered from comorbidities and whether these impact their life expectancy or their access to KT. We found that more and more children with kidney failure suffer from comorbidities when starting kidney replacement therapy. We also found that these children have a lower access to KT and a higher mortality on dialysis compared with children without comorbidities, especially in low-income countries. After KT, children with comorbidities have a similar mortality and graft survival compared with children without comorbidities. We concluded that reduced access to a kidney transplant might represent a modifiable barrier to KT in children with comorbidities, especially in low-resource countries. We suggest that children with comorbidities in need for kidney replacement therapy should be rapidly evaluated for eligibility for KT.
VL  - 16
IS  - 4
AV  - public
ER  -