University of Calgary, and Alberta Children’s Hospital, Calgary, Alberta, Canada.
Clin J Am Soc Nephrol. 2011 May;6(5):1094-9. doi: 10.2215/CJN.04920610. Epub 2011 Mar 10.
Long-term follow-up data are few in children with ESRD. We sought to describe long-term survival, assess risk factors for death, and compare survival between two time periods in pediatric ESRD patients.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We used a population-based retrospective cohort utilizing data from a national organ failure registry and from Canada's universal healthcare system. We included 843 children (ages, 0 to 18) initiating renal replacement therapy from 1992 to 2007 and followed them until death or date of last contact (median follow-up, 6.8 years; interquartile range, 3.0 to 10.6). We assessed risk factors for death and examined cause-specific mortality.
During 5991 patient-years of follow-up, 107 (12.7%) patients died. Unadjusted cumulative survival for the cohort was: 91.7% (95% CI, 89.8 to 93.7%) at 5 years and 85.8% (95% CI, 82.8 to 88.8%) at 10 years. Among patients commencing dialysis, overall adjusted survival was poorest among those who started dialysis at age <1 year. No secular trends in survival were noted for either dialysis or transplant patients. The proportion of incident patients receiving pre-emptive transplantation increased over time. Pre-emptively transplanted patients did not demonstrate superior adjusted survival compared with those who spent >2 years on dialysis before transplant (hazard ratio, 1.53; 95% CI, 0.63 to 3.67).
No significant improvements in survival were observed among ESRD patients over the study period. Time with transplant function had the strongest association with survival. Pre-emptive transplantation was not associated with improved survival in adjusted models.
患有终末期肾病的儿童的长期随访数据很少。我们旨在描述长期生存情况，评估死亡风险因素，并比较儿童终末期肾病患者两个时期的生存情况。
设计、设置、参与者和测量：我们使用了一项基于人群的回顾性队列研究，利用来自国家器官衰竭登记处和加拿大全民医疗保健系统的数据。我们纳入了 1992 年至 2007 年期间开始接受肾脏替代治疗的 843 名儿童（年龄 0 至 18 岁），并对其进行随访直至死亡或最后一次随访日期（中位随访时间为 6.8 年；四分位间距为 3.0 至 10.6）。我们评估了死亡的风险因素，并检查了病因特异性死亡率。
在 5991 患者-年的随访期间，有 107 名（12.7%）患者死亡。队列的未调整累积生存率为：5 年时为 91.7%（95%可信区间，89.8%至 93.7%），10 年时为 85.8%（95%可信区间，82.8%至 88.8%）。在开始透析的患者中，年龄<1 岁开始透析的患者总体调整后生存率最差。透析或移植患者的生存率均未出现明显的时间趋势。接受抢先移植的新发患者比例随时间推移而增加。与在移植前接受透析>2 年的患者相比，抢先移植的患者并未表现出调整后生存率的优势（风险比，1.53；95%可信区间，0.63 至 3.67）。
在研究期间，终末期肾病患者的生存率没有明显提高。移植肾功能持续时间与生存情况关系最密切。在调整模型中，抢先移植与改善生存率无关。
