Mortazavi F, Maleki M
Department of Pediatric Nephrology, Tabriz University of Medical Sciences, Pediatric Health Research Centre, Tabriz, Iran.
Indian J Nephrol. 2012 Mar;22(2):94-7. doi: 10.4103/0971-4065.97113.
Outcome of end-stage renal disease (ESRD) in children has considerably improved since the development of dialysis and kidney transplantation. This study was conducted to evaluate the management and outcome of ESRD children in a referral pediatric center in northwest Iran. A cross-sectional study of medical records of ESRD children (glomerular filtration rate less than 15 ml/min/1.73 m(2)) younger than 16 years who were admitted in Children's Hospital of Tabriz between October 1999 and October 2009 was performed. Ninety-four children with ESRD including 51 boys (54.3%) and 43 girls (45.7%) with a mean age of 7.9 ± 3.49 years were studied. Parents of nine patients (7.8%) refused treatment. Eighty patients underwent renal replacement therapy (RRT) and were followed for a mean period of 4.86 ± 2.77 years. Initial modality of RRT was hemodialysis in 81.25%, continuous ambulatory peritoneal dialysis in 16.25%, and preemptive kidney transplantation in 2.5%. Thirty-two patients (34%) underwent renal transplantation. The mean duration of staying on dialysis before transplantation was 12.4 ± 11 months. Twenty-nine of kidney donors (90.6%) were living unrelated donors. The 1-and 3-year graft survival rates were 81.2% and 68.8% and the 1- and 3-year patient survival rates were 96.9% and 93.8%, respectively. Thirty-one patients died (33%). The mortality of girls was significantly higher than boys (P=0.04). There was a significant negative correlation between age and mortality (P=0.01). Heart failure and infections were the most common cause of death. This study showed that ESRD children in our area have a poor outcome in comparison with developed countries.
自透析和肾移植技术发展以来，儿童终末期肾病（ESRD）的治疗效果有了显著改善。本研究旨在评估伊朗西北部一家转诊儿科中心对ESRD儿童的管理及治疗效果。对1999年10月至2009年10月期间在大不里士儿童医院住院的16岁以下ESRD儿童（肾小球滤过率低于15 ml/min/1.73 m²）的病历进行了横断面研究。研究了94例ESRD儿童，其中包括51名男孩（54.3%）和43名女孩（45.7%），平均年龄为7.9 ± 3.49岁。9名患者（7.8%）的家长拒绝治疗。80例患者接受了肾脏替代治疗（RRT），平均随访时间为4.86 ± 2.77年。RRT的初始方式为血液透析的占81.25%，持续性非卧床腹膜透析的占16.25%，抢先肾移植的占2.5%。32例患者（34%）接受了肾移植。移植前透析的平均持续时间为12.4 ± 11个月。29名肾脏供体（90.6%）为非亲属活体供体。1年和3年的移植存活率分别为81.2%和68.8%，1年和3年的患者存活率分别为96.9%和93.8%。31例患者死亡（33%）。女孩的死亡率显著高于男孩（P = 0.04）。年龄与死亡率之间存在显著负相关（P = 0.01）。心力衰竭和感染是最常见的死亡原因。本研究表明，与发达国家相比，我们地区的ESRD儿童治疗效果较差。
