Montez de Sousa Iris R, Bonthuis Marjolein, Kramer Anneke, Ordoñez Flor Angel, de la Cerda Ojeda Francisco, Rydell Helena, Helve Jaakko, Groothoff Jaap W, Hommel Kristine, Buchwinkler Lukas, Segelmark Mårten, Arici Mustafa, Palsson Runolfur, Bell Samira, Trujillo-Alemán Sara, Bakkaloglu Sevcan A, Sørensen Søren S, Vila Anna, Ortiz Alberto, Stel Vianda S, Jager Kitty J
ESPN/ERA Registry, Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 2025 Apr 1;40(4):707-719. doi: 10.1093/ndt/gfae189.
Young adults starting kidney replacement therapy (KRT) during childhood and reaching their 18th birthday (i.e. adult survivors of childhood KRT) form a challenging population of interest to nephrologists treating adults, as during this period there will be a transition to adult renal centres. Nonetheless, few studies have focused on the epidemiology of KRT in this group. We aimed to provide an update on these patients' characteristics, treatment history, and graft and patient survival, to report their 5-year prognosis and expected remaining lifetime.
Data on KRT patients reaching their 18th birthday in 2008-19 were collected from 21 European countries/regions providing individual patient data to the European Renal Association (ERA) Registry. Patient characteristics and treatment trajectories were examined before and after turning 18 years old. Kaplan-Meier and Cox proportional hazards regression were used for patient and graft survival analyses.
In total, 2944 patients were included. The proportion of adult survivors initiating KRT at a very young age (0-4 years) and undergoing pre-emptive kidney transplantation increased. Unadjusted 5-year patient survival was 96.9% [95% confidence interval (CI) 96.2-97.5]. Dialysis patients had a higher risk of death than kidney transplant recipients [adjusted hazard ratio 5.44 (95% CI 3.34-8.86)]. Between ages 18 and 23 years, about 21% of the adult survivors lost their kidney transplant and 34% of the dialysis patients continued this treatment. Compared with the general population, life expectancy for 18-year-old kidney transplant and dialysis patients was 17 and 40 years shorter, respectively.
Life expectancy of 18-year-old kidney transplant recipients was lower compared with the general population, yet having a functioning kidney graft at age 18 years resulted in better outcomes than being on dialysis. Nevertheless, between ages 18 and 23 years, about one-fifth of the kidney grafts failed and one-third of the patients remained on dialysis.
在儿童期开始肾脏替代治疗（KRT）并年满18岁的年轻人（即儿童期KRT的成年幸存者），对于治疗成人患者的肾病学家而言是一个具有挑战性的关注群体，因为在此期间他们将转至成人肾脏中心。尽管如此，很少有研究聚焦于该群体的KRT流行病学。我们旨在更新这些患者的特征、治疗史、移植肾及患者生存率，报告他们的5年预后及预期剩余寿命。
收集了2008年至2019年年满18岁的KRT患者的数据，这些数据来自向欧洲肾脏协会（ERA）注册中心提供个体患者数据的21个欧洲国家/地区。对患者18岁前后的特征及治疗轨迹进行了检查。采用Kaplan-Meier法和Cox比例风险回归进行患者及移植肾生存分析。
共纳入2944例患者。极幼年（0至4岁）开始KRT并接受抢先肾移植的成年幸存者比例有所增加。未经调整的5年患者生存率为96.9%[95%置信区间（CI）96.2 - 97.5]。透析患者的死亡风险高于肾移植受者[调整后风险比5.44（95%CI 3.34 - 8.86）]。在18至23岁之间，约21%的成年幸存者失去了他们的肾移植，34%的透析患者继续接受这种治疗。与一般人群相比，18岁的肾移植患者和透析患者的预期寿命分别短17年和40年。
18岁的肾移植受者的预期寿命低于一般人群，但18岁时拥有一个功能良好的移植肾比接受透析的结局更好。然而，在18至23岁之间，约五分之一的移植肾失败，三分之一的患者仍接受透析治疗。
