Initiating Dialysis With Higher Kidney Function may Pose Death Risk in Children

Children with kidney failure, who start dialysis early with a higher kidney function, are at a greater risk of dying. On the other hand, delayed dialysis may benefit asymptomatic children.

Highlights:

In recent years, dialysis for children have been started at higher levels of kidney function
Children with higher kidney function at dialysis commencement are at a greater risk of death
The risk is even greater for the children with higher kidney function who are on hemodialysis compared to peritoneal dialysis
Delayed dialysis may prove beneficial for asymptomatic children

Higher kidney function at dialysis initiation was tied to lower survival in children, reports a new study. The study findings suggest that asymptomatic children with kidney failure may benefit from delaying dialysis.

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‘Starting dialysis with higher kidney function may increase death risk in children. Children who initiated treatment with hemodialysis were at a higher risk of death compared to those on peritoneal dialysis. However, delaying dialysis may benefit asymptomatic children. ’
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Kidney Failure in Children

Kidney transplantation would be the ideal treatment for children suffering from kidney failure. However, most children began with dialysis prior to the transplant in order to address various issues like electrolyte balancing, removing excess fluids from the body, and alleviating excess fatigue.

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 dialysis 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.

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Details of the Study

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.

The team 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.

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Findings of the Study

Among 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 dialysis. 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,” said Dr. 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,” she added.

In an 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.”

Reference:

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)

Source-Medindia

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