Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was  yrs. (range: 1 month–24 yrs). Forty-five children (42) had dysplastic kidneys and 19 (17.5) had focal segmental glomerulosclerosis. Twenty-five (22.7) received peritoneal dialysis, 59 (53.6) hemodialysis, and 6 (23.6) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was  yrs. Seventy-nine patients (71.8) underwent successful transplantation, 10 (11.2) had graft failure, and 8 (7.3) continued dialysis without transplantation. Twelve patients (10.9) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84: 90 for patients older than 5 years and 61 for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications.