Characteristics and survival of young adults who started renal replacement therapy during childhood
Characteristics and survival of young adults who started renal replacement therapy during childhood
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DOI：
10.1093/ndt/gfn542
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发表时间：
2009-03-01
影响因子：
6.1
通讯作者：
Jager, Kitty J.
中科院分区：
文献类型：
--
作者：
Kramer, Anneke;Stel, Vianda S.;Jager, Kitty J.
背景资料。人们对接受肾脏替代疗法(RRT)的儿童群体知之甚少，这些儿童年满18岁，从儿科转到成人肾病服务机构。本研究的目的是描述这些在儿童时期开始进行RRT的年轻人的人口统计学、原发肾脏疾病、治疗史，并确定死亡的危险因素。我们纳入了1777名年轻成年人，他们在孩提时代就开始了RRT，并在1985至2004年间从9个欧洲肾脏注册机构向ERA-EDTA注册中心提交数据，年满18岁。组间比较采用卡方检验，生存分析采用COX回归分析。在儿童时期开始RRT的年轻人每年使开始RRT的成人患者总数增加1.5%。在1985年至2004年期间，每百万人中年满18岁的RRT儿童人数从71人增加到116人。随着时间的推移，在很小的年龄就开始RRT的年轻人的比例增加了，患有发育不良/发育不良和囊性肾脏的儿童的数量增加了，更多的年轻人开始了RRT，开始了腹膜透析或预防性移植。18岁时未调整的5年生存率为95.1%(95%可信区间为93.9~96.0)。移植肾功能正常的年轻人的平均预期寿命为63岁，而仍在透析的年轻人的平均预期寿命为38岁。接受RRT治疗的年轻人的PMarp数量随着时间的推移而增加。他们的特征和治疗史发生了变化。他们的存活前景很好；然而，移植受者的预期剩余寿命至少是接受透析的年轻人的两倍。
Background. Little is known about the group of children on renal replacement therapy (RRT) who reach the age of 18 years and are transferred from paediatric to adult nephrology services. The aim of this study was to describe patient demographics, primary renal diseases, treatment history and determine the risk factors for mortality of these young adults who started RRT in childhood.Methods. We included 1777 young adults who had started RRT during childhood and turned 18 between 1985 and 2004 from nine European renal registries submitting data to the ERA-EDTA Registry. The chi-square test was used to test differences between patient groups and Cox regression analysis to examine patient survival.Results. Young adults who began RRT during childhood increased the total number of adult patients starting RRT by 1.5% per annum. The annual number of children on RRT turning 18, per million persons (Pmarp) reaching the age of 18 years, increased between 1985 and 2004 from 71 to 116. Over time, there was an increase in the percentage of young adults who started RRT at a very young age, a greater number of children with hypoplasia/dysplasia and cystic kidneys and more young adults who started RRT with peritoneal dialysis or pre-emptive transplantation. The unadjusted 5-year patient survival from the 18th birthday was 95.1% (95% CI 93.9-96.0). The average life expectancy was 63 years for young adults with a functioning graft and 38 years for those remaining on dialysis.Conclusions. The number Pmarp of young adults on RRT has increased over time. Their characteristics and treatment history changed. Their survival prospects are good; however, transplant recipients have an expected remaining lifetime that is at least twice as high as for young adults on dialysis.