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Arch Dis Child. Dec 2002; 87(6): 511–517.
PMCID: PMC1755807

Outcome of reaching end stage renal failure in children under 2 years of age

Abstract

Aims: To determine the outcome of children who reach end stage renal failure before the age of 2 years.

Methods: Using a retrospective questionnaire, 10 years' data were collected from the paediatric nephrology units in Britain and Ireland (1988 to 1997, follow up 1.3–11.5 years).

Results: A total of 192 children were identified; 0.31/million/year. Most had congenital or inherited conditions, and there were more boys. Latterly, half were diagnosed antenatally. Ninety per cent were dialysed initially, most using home peritoneal cyclers, some by haemodialysis through central lines. Five per cent recovered sufficient function to come off dialysis. Most required tube feeding (often gastrostomy) and erythropoietin; some needed growth hormone. A total of 56% received a transplant (2% without prior dialysis) at (medians) 2.6 years and 12.3 kg. The 2 and 10 year survival of first kidneys was 78%. Growth improved following transplantation. Fourteen per cent died because treatment was not started or was withdrawn. Most had particularly complex renal conditions, or additional major non-renal diagnoses. Typically, decisions not to treat were made mutually between clinicians and families. When treatment was continued, 71% survived, and few had serious non-renal conditions. Most attended normal schools, and by 6 years of age, less than 10% still required dialysis. Infants starting treatment under and over 1 month of age fared equally well.

Conclusions: By school age, most infants treated for end stage renal failure will have a functioning transplant, reasonable growth, and will attend a normal class, regardless of the age at which they commence treatment. Treatment is seldom sustained in children who have serious additional medical conditions. It is reasonable to treat infants with uncomplicated renal failure.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rizzoni G, Malekzadeh MH, Pennisi AJ, Ettenger RB, Uittenbogaart CH, Fine RN. Renal transplantation in children less than 5 years of age. Arch Dis Child. 1980 Jul;55(7):532–536. [PMC free article] [PubMed]
  • Moel DI, Butt KM. Renal transplantation in children less than 2 years of age. J Pediatr. 1981 Oct;99(4):535–539. [PubMed]
  • Arbus GS, Geary DF, McLorie GA, Major ML, Berdock SE, Freedman L, Baumal R. Pediatric renal transplants: a Canadian perspective. Kidney Int Suppl. 1986 Jul;19:S31–S34. [PubMed]
  • Fine RN. Renal transplantation of the infant and young child and the use of pediatric cadaver kidneys for transplantation in pediatric and adult recipients. Am J Kidney Dis. 1988 Jul;12(1):1–10. [PubMed]
  • McGraw ME, Haka-Ikse K. Neurologic-developmental sequelae of chronic renal failure in infancy. J Pediatr. 1985 Apr;106(4):579–583. [PubMed]
  • So SK, Mauer SM, Nevins TE, Fryd DS, Sutherland DE, Ascher NL, Simmons RL, Najarian JS. Current results in pediatric renal transplantation at the University of Minnesota. Kidney Int Suppl. 1986 Jul;19:S25–S30. [PubMed]
  • So SK, Chang PN, Najarian JS, Mauer SM, Simmons RL, Nevins TE. Growth and development in infants after renal transplantation. J Pediatr. 1987 Mar;110(3):343–350. [PubMed]
  • Kohaut EC, Tejani A. The 1994 annual report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1996 Aug;10(4):422–434. [PubMed]
  • Warady BA, Hébert D, Sullivan EK, Alexander SR, Tejani A. Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1997 Feb;11(1):49–64. [PubMed]
  • Bunchman TE. Infant dialysis: the future is now. J Pediatr. 2000 Jan;136(1):1–2. [PubMed]
  • Geary DF. Attitudes of pediatric nephrologists to management of end-stage renal disease in infants. J Pediatr. 1998 Jul;133(1):154–156. [PubMed]
  • Kari JA, Romagnoli J, Duffy P, Fernando ON, Rees L, Trompeter RS. Renal transplantation in children under 5 years of age. Pediatr Nephrol. 1999 Nov;13(9):730–736. [PubMed]
  • Ledermann SE, Shaw V, Trompeter RS. Long-term enteral nutrition in infants and young children with chronic renal failure. Pediatr Nephrol. 1999 Nov;13(9):870–875. [PubMed]
  • Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L. Outcome and growth of infants with severe chronic renal failure. Kidney Int. 2000 Apr;57(4):1681–1687. [PubMed]
  • Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS. Long-term outcome of peritoneal dialysis in infants. J Pediatr. 2000 Jan;136(1):24–29. [PubMed]
  • Al-Hermi BE, Al-Saran K, Secker D, Geary DF. Hemodialysis for end-stage renal disease in children weighing less than 10 kg. Pediatr Nephrol. 1999 Jun;13(5):401–403. [PubMed]
  • Coulthard MG, Sharp J. Haemodialysing infants: theoretical limitations, and single versus double lumen lines. Pediatr Nephrol. 2001 Apr;16(4):332–334. [PubMed]
  • McDonald R, Donaldson L, Emmett L, Tejani A. A decade of living donor transplantation in North American children: the 1998 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant. 2000 Aug;4(3):221–234. [PubMed]
  • Elshihabi I, Chavers B, Donaldson L, Emmett L, Tejani A. Continuing improvement in cadaver donor graft survival in North American children: the 1998 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Pediatr Transplant. 2000 Aug;4(3):235–246. [PubMed]
  • Millan MT, Sarwal MM, Lemley KV, Yorgin P, Orlandi P, So S, Alexander S, Salvatierra O., Jr A 100% 2-year graft survival can be attained in high-risk 15-kg or smaller infant recipients of kidney allografts. Arch Surg. 2000 Sep;135(9):1063–1069. [PubMed]

Figures and Tables

Figure 1
The outcome of 192 children who reached end stage renal failure under the age of 2 in the UK. In the bottom line the figures in plain boxes represent live children, and those in shaded boxes children that have died.
Figure 2
Kaplan-Meier plot of children who reached end stage renal failure before the age of 2, showing the age at which the transplanted children received their first graft. The numbers of cases available for analysis are indicated by the vertical bars and numbers. ...
Figure 3
Patient and kidney survival curves after the first graft into 107 chilren who reached end stage renal failure before the age of 2. The numbers of cases available for analysis are indicated by the vertical bars.
Figure 4
The most recent height and weight values for 63 boys and 23 girls who currently have a functioning transplant, compared to the normal 2nd, 50th, and 98th centiles.
Figure 5
Survival curves for children who reached end stage renal failure before the age of 2, and died (a) because treatment was not started, (b) because treatment was withdrawn, or (c) despite remaining on dialysis.

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