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- Title
Demographics and long‐term outcomes of children with end‐stage kidney disease: A 20‐year territory‐wide study.
- Authors
Chan, Eugene Yu Hin; Yap, Desmond Yat Hin; Wong, Wilfred Hing Sang; Ho, Tsz Wai; Tong, Pak Chiu; Lai, Wai Ming; Chan, Tak Mao; Ma, Alison Lap Tak
- Abstract
Aim: To evaluate the demographics and long‐term patient outcomes of children with end‐stage kidney disease in Hong Kong. Methods: We conducted a cohort study at the Paediatric Nephrology Centre, the designated site providing kidney replacement therapy (KRT) for children in Hong Kong. The clinical characteristics and outcomes of all children who initiated chronic KRT before 19 years, between 2001 and 2020, were analysed. Results: One hundred forty‐seven children (50% male) received KRT at a mean age of 11.4 ± 5.7 years. The incidence of ESKD was 6.28 per million age‐related population (pmarp). The leading cause of ESKD was congenital anomalies (33%). Ten children (7%) had pre‐emptive kidney transplants, 104 (71%) and 33 (22%) patients received automated peritoneal dialysis and haemodialysis as initial KRT. The incidence of ESKD increased over time, and were 4.38, 5.07, 6.15 and 9.17 pmarp during 2001–2005, 2006–2010, 2011–2015 and 2016–2020, respectively (p =.005). Ninty‐seven patients (66%) received kidney transplants and the median time to receive a kidney graft was 3.7 years (95% CI 3.1–4.3). Only 10 patients had pre‐emptive kidney transplants. The mortality rate was 9.1 deaths per 1000‐patient‐years (95%CI 4.6–16.2). The survival probabilities at 1‐, 5‐, 10‐ and 15‐year were 100%, 94.8% (95%CI 90.7–98.9%), 89.7% (95% CI 83.4%–95.9%), 87.1% (95% CI 79.3%–94.9%), respectively. Standardised mortality ratio was 54.5. 72% of deaths were due to infections. Young infants and those without kidney transplants were associated with worse survival (p <.01). Multivariate analysis demonstrated that dialysis was the only factor associated with significantly increased risk of death (HRadj 12.9, 95% CI 2.7–63.2, p =.002). Conclusion: We observed an increasing incidence of paediatric ESKD in Hong Kong with considerable waiting time to kidney transplant. Mortality risk is comparable to other developed countries and is highest among dialysis population. Efforts should be made to facilitate early access to paediatric kidney transplantation in Hong Kong. SUMMARY AT A GLANCE: The incidence of kidney failure per million age‐related population in Hong Kong has more than doubled from 2001–2005 to 2016–2020, with a considerable waiting time to kidney transplantation. Mortality risk is comparable to that observed in other developed countries and is highest among those on dialysis. Efforts should be made to facilitate early transition to paediatric kidney transplantation.
- Subjects
HONG Kong (China); CHRONIC kidney failure; PEDIATRIC nephrology; RENAL replacement therapy; KIDNEY transplantation; PERITONEAL dialysis; KIDNEY failure
- Publication
Nephrology, 2022, Vol 27, Issue 2, p171
- ISSN
1320-5358
- Publication type
Article
- DOI
10.1111/nep.14007