Outcomes of dialysis initiated during the neonatal period for treatment of end-stage renal disease: A North American Pediatric Renal Trials and Collaborative Studies special analysis
Outcomes of dialysis initiated during the neonatal period for treatment of end-stage renal disease: A North American Pediatric Renal Trials and Collaborative Studies special analysis
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DOI：
10.1542/peds.2006-1754
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发表时间：
2007-02-01
期刊：
影响因子：
8
通讯作者：
Mathias, Robert S.
中科院分区：
文献类型：
--
作者：
Carey, William A.;Talley, Lynya I.;Mathias, Robert S.
目标。我们试图确定对患有终末期肾病的新生儿和1 ~ 24个月的儿童进行长期透析的结局。患者和方法。通过查询北美儿科肾脏试验和合作研究数据库，我们获得了193名推定诊断为终末期肾病并开始长期透析的新生儿（1-24个月）的信息。采用chi(2)检验比较透析特征和住院可能性，采用Wilcoxon 2样本检验比较住院时间。采用产品限制方法，并使用对数秩检验来比较时间-事件分析。采用Cox比例风险模型进行多因素分析。患有终末期肾病的新生儿比患有终末期肾病的大龄儿童更可能接受腹膜透析而不是血液透析。此外，在出生后第一个月开始透析的新生儿与年龄较大的儿童一样有可能终止透析。与年龄较大的儿童相比，新生儿的肾移植率明显较低，但新生儿更有可能恢复肾脏的功能。虽然新生儿更常住院，但他们的总体死亡风险与大龄儿童相似。推定诊断为终末期肾病的新生儿可能在出生后的第一个月开始长期透析，其结果与在婴儿期后期开始透析的患者相当。
OBJECTIVE. We sought to determine the outcomes of initiating long-term dialysis of neonates and children aged > 1 to 24 months with end-stage renal disease.PATIENTS AND METHODS. By querying the North American Pediatric Renal Trials and Collaborative Studies database, we obtained information on 193 neonates ( 1-24 months of age) with a presumptive diagnosis of end-stage renal disease who initiated long-term dialysis. Dialysis characteristics and likelihood of hospitalization were compared using the chi(2) test, and duration of hospitalization was compared using the Wilcoxon 2-sample test. Product limit methods were implemented, and the log rank test was used to compare time-to-event analyses. Multivariate analyses were performed using Cox proportional hazards models.RESULTS. Neonates with end-stage renal disease were more likely to receive peritoneal dialysis versus hemodialysis than older children with end-stage renal disease. Moreover, neonates who initiated dialysis during the first month of life were just as likely to terminate dialysis as were the older children. Rates of renal transplantation were significantly lower in the neonates compared with the older children, but neonates were more likely to recover function of the native kidney. Although neonates were more often hospitalized, their overall risk of mortality was similar to that observed in older children.CONCLUSIONS. Neonates with a presumptive diagnosis of end-stage renal disease may initiate long-term dialysis during the first month of life with outcomes comparable to those of patients who initiate dialysis later in infancy.