The US incident pediatric (0-19 years old) ESRD population has shown moderate growth; increasing 6.1% since 20005. In 2007, 1,245 children started ESRD therapy, for a rate of 14.6 per million population5. Geographic variability was noted due to economic and social conditions6. The US prevalent pediatric ESRD population has nearly tripled since 1980, yet this growth appears to be slowing, with an increase of 11.4% since 20005. Cystic, hereditary, and congenital diseases were the most prominent diagnoses across all pediatric age groups, increasing approximately 16% during the 2002-2007 time period compared to the 1997-2001 time period5.
Incident counts and adjusted rates, by modality5
Incident ESRD patients, age 0-19. Adjusted for age, gender, race, & primary diagnosis
Prevalent counts and adjusted rates, by modality5
December 31 point prevalent ESRD patients, age 0-19. Adjusted for age, gender, race, & primary diagnosis
These statistics create unique disease management challenges compounded by the fact that the predominant initial treatment modality for ESRD pediatric patients is HD via a catheter. In those children not under the care of a nephrologist prior to ESRD, catheter use reached 63.6% in 2007, while in those children seeing a nephrologist for greater than 12 months prior to ESRD, catheter use dropped to 34.9%5. Event rates for infection and sepsis among new pediatric HD patients dialyzing with a catheter rose 133% between 2004-2006 translating to 181 events per 100 patient years5. An infectious or septic event occurs much earlier in children who initiate dialysis with a HD catheter than in those who start with an arterio¬venous fistula (AVF) or a peritoneal access. At the end of one year, children with HD catheters have a 50% chance of an infection or septic event whereas starting HD in children with AVF as an access, decreased rates of infection and sepsis by 38.8 and 54.1 percent between 2001–2003 and 2004–20065. Realizing the advantages of AVF in the pediatric patient and looking to help centers overcome obstacles unique to children with ESRD, the International Pediatric Fistula First Initiative (IPPFI) was launched in 2005 through the Midwest Pediatric Nephrology Consortium (www.mwpnc.org).
The most striking findings related to prevalent pediatric populations center on the lack of improvement in patient survival over the past decade. In the dialysis population, mortal-ity rates by age are similar across pediatric age groups, but differ widely from those in the adult population. For example, in 2006, the all-cause mortality rate in children was 50.6 per 1,000 patient years, compared to 224 per 1,000 patient years in adults5. But while mortality among adult dialysis patients has been falling since the late 1990s, rates for children have not shown a similar consistent pattern. This is a central concern and suggests the need for increased efforts to continue development of new approaches for improving outcomes and early identification of kidney disease risk factors.
5. United States Renal Data System. Retrieved from www.usrds.org on October 5, 2009
6. Warady BA, Alexander SR, Balfe JW, Harvey E. Peritoneal Dialysis in Children. In: Gokal R, Khanna R, Krediet RTh, Nolph KD, eds. Textbook of Peritoneal Dialysis, 2nd ed. Dodrecht/Boston/London: Kluwer Academic Publishers, 2000:667-708
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