Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan.
Medical Informatics, St. Marianna University School of Medicine, Kawasaki, Japan.
Clin Exp Nephrol. 2020 Jan;24(1):82-87. doi: 10.1007/s10157-019-01788-5. Epub 2019 Sep 20.
Although there is debate regarding the timing of initiation of renal replacement therapy (RRT) in adults with end-stage renal disease, there is a paucity of reliable epidemiological data on pediatric patients. The present study was performed to investigate current practice in Japan with regard to the timing of initiation of RRT in children based on estimated glomerular filtration rate (eGFR).
A total of 649 pediatric patients < 20 years old with eGFR at the initiation of RRT between 1 January 2006 and 31 December 2013 were included in the study. Baseline eGFR was calculated for each patient using the Schwartz formula.
eGFR at the start of RRT was 12.1 mL/min/1.73 m [interquartile range (IQR) 8.4-16.3]. A total of 209 children (32.2%) had high eGFR (eGFR > 15 mL/min/1.73 m) at the initiation of RRT. Initiation of RRT was more likely in those undergoing preemptive transplantation (PEKT) with high eGFR [odds ratio (OR) 4.16; 95% confidence interval (CI) 1.95-8.90, P < 0.001]. There were 31 deaths of various causes during follow-up, with infections representing the leading causes of death.
The median eGFR at the initiation of RRT in children showed a wide range of variation. Further studies are needed to investigate the impact of the decision regarding when to initiate RRT in individual pediatric patients.
尽管成人终末期肾病患者开始肾脏替代治疗（RRT）的时机存在争议，但关于儿科患者的可靠流行病学数据却很少。本研究旨在根据估算肾小球滤过率（eGFR）调查目前日本儿科患者开始 RRT 的时机。
研究共纳入了 2006 年 1 月 1 日至 2013 年 12 月 31 日期间开始 RRT 时年龄<20 岁且 eGFR 处于基线水平的 649 例儿科患者。每位患者的基线 eGFR 均采用 Schwartz 公式进行计算。
RRT 起始时 eGFR 为 12.1 mL/min/1.73 m [四分位间距（IQR）为 8.4-16.3]。共有 209 例（32.2%）患者在开始 RRT 时 eGFR 较高（eGFR>15 mL/min/1.73 m）。高 eGFR 的患者（eGFR>15 mL/min/1.73 m）更有可能进行预防性移植（PEKT）[比值比（OR）4.16；95%置信区间（CI）1.95-8.90，P<0.001]。在随访期间，有 31 例患者死于各种原因，感染是主要的死亡原因。
儿童开始 RRT 时的 eGFR 中位数存在较大的差异。需要进一步研究来探讨何时对个体儿科患者开始 RRT 的决策的影响。
