Life expectancy after pediatric dialysis is shorter than after kidney transplantation

Researchers report that children who receive renal replacement therapy (KRT) and survive into adulthood have a longer life expectancy if they receive a kidney transplant compared with those who receive dialysis.

Dr. Marjolein Bonthuis of the University of Amsterdam in the Netherlands and her colleagues used the ERA Registry, representing 21 European countries, from 2008 to 2019 to identify 2,944 adult survivors who received KRT as children. After reaching age 18, the unadjusted 5-year survival rate for this cohort was 96.9%, the researchers reported. Nephrology, dialysis and transplantation.

Patients who underwent dialysis rather than kidney transplantation during childhood had a significantly increased risk of death within 5 years (by age 23 years) by 5.4 times. The overall risk of death was 6.2 times higher after childhood hemodialysis and 3.5 times higher after childhood peritoneal dialysis. The longer the cumulative duration of dialysis, the higher the risk of death. Patients who underwent dialysis for ≥3 years or 1-3 years during childhood had a significantly increased overall risk of death of 5.6 times and 2.7 times, respectively, compared with patients who did not undergo dialysis. Approximately 34% of patients who underwent dialysis during childhood continued this treatment between ages 18 and 23 years.

Approximately 21% of adult survivors lost their kidney transplants between the ages of 18 and 23. The risk of transplant failure within five years of turning 18 was significantly increased by 24% for those who received a cadaveric kidney transplant rather than a living donor kidney transplant.

The researchers also measured the patients' life expectancy. Compared to the general adult population, survivors aged 18 and older can expect to live 40 years less if they underwent dialysis as children and 17 years less if they had a kidney transplant as a child. Among dialysis patients, women had shorter life expectancy than men, 43.6 years less and 37.1 years less, respectively.

The researchers reported that the proportion of adult survivors of pediatric KRT who reached their 18th birthday remained stable from 2008 to 2019. The proportion of adult survivors who initiated KRT at a very young age (0-4 years) and underwent prophylactic kidney transplantation has increased over time. Between KRT initiation and age 18 years, 41.9%, 11.6%, and 9.4% of patients in this cohort underwent one, two, and three or more treatment changes, respectively.

“Health policy should aim to reduce the duration of dialysis during childhood through continued efforts to improve pediatric kidney allocation policies,” Dr. Bontois and his team wrote.