ESPN 53rd Annual Meeting

ESPN 2021


 
Early versus Late Requirement for Renal Replacement Therapy in Children at Presentation: Early and Medium-term Outcomes
JACQUELINE SIT 1 CAROLINE BOOTH 1 NABIL MELHEM 1 MANISH SINHA 1

1- EVELINA LONDON CHILDREN’S HOSPITAL, GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST
 
Abstract:

Objectives

Nearly 25% children start renal replacement therapy (RRT) within 90 days of presenting to paediatric nephrology services in the UK (early requirement for RRT). The objective of this study was to compare the clinical characteristics, the early and medium-term outcomes of children who had early requirement (ER) versus late requirement (LR) for RRT. 

 

Methods

This was a retrospective study of all children with chronic kidney disease (CKD) who were initiated on RRT at the Evelina London Children’s Hospital between 2012-2016. Demographics, primary renal disease (PRD), date of presentation, biochemical parameters, dialysis modality, complications and transplant details were recorded. 

 

Results

There were 86 patients in the study, 32.6% had ER and 67.4% had LR for RRT. Patients with ER for RRT at presentation were likely to be female(p=0.046), older(p<0.001), with different PRD’s (higher rates of hereditary nephropathies, miscellaneous renal disorders, and systemic diseases) and with lower eGFR (p=0.002). There were no differences in ethnicity (p=0.48) and socioeconomic status (p=0.26).

 

Patients with ER had higher urea (p=0.02), higher phosphate (p<0.001) and were more acidotic (p=0.01) at initiation of RRT. They had a shorter time interval between presentation and transplant (1.3 vs 5.2 years, p<0.001), and were more likely to change dialysis modality in the first 2 years (p<0.001). 

 

There were no differences in the number transplanted (p=0.33), donor source (p=0.22), or age at transplantation (p=0.29). There were no differences in the need for (p=0.7) and the time intervals between switching RRT modalities (p=0.6). 

 

Conclusion

Patients who had early requirement for RRT had poorer outcomes and worse biochemical parameters at initiation of RRT. They were more likely to require changes in dialysis modalities in the first 2 years and have less access to preparation before initiation of dialysis or pre-emptive transplant. Research to identify opportunities for earlier detection of CKD in children is needed.