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https://hdl.handle.net/2440/9970
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Type: | Journal article |
Title: | Long-term survival of children with end-stage renal disease |
Author: | McDonald, S. Craig, J. |
Citation: | New England Journal of Medicine, 2004; 350(26):2654-2662 |
Publisher: | Massachusetts Medical Soc |
Issue Date: | 2004 |
ISSN: | 0028-4793 1533-4406 |
Statement of Responsibility: | Stephen P. McDonald, and Jonathan C. Craig |
Abstract: | <h4>Background</h4>Although renal-replacement therapy for children with end-stage renal disease has been used for several decades, data on patients' long-term survival are sparse.<h4>Methods</h4>We examined the long-term survival of all children and adolescents who were under 20 years of age when renal-replacement therapy commenced (study period, April 1963 through March 2002), using data from the Australia and New Zealand Dialysis and Transplant Registry. Survival was analyzed with the use of Kaplan-Meier methods and age-standardized mortality rates. Risk factors for death were analyzed with the use of Cox regression analysis with time-dependent covariates.<h4>Results</h4>A total of 1634 children and adolescents were followed for a median of 9.7 years. The long-term survival rate among children requiring renal-replacement therapy was 79 percent at 10 years and 66 percent at 20 years. Mortality rates were 30 times as high as for children without end-stage renal disease. Risk factors for death were a young age at the time renal-replacement therapy was initiated (especially for children under 1 year of age, among whom the risk was four times as high as for children 15 to 19 years of age) and treatment with dialysis (which was associated with a risk more than four times as high as for renal transplantation). Overall, a trend toward improved survival was observed over the four decades of the study.<h4>Conclusions</h4>Despite improvement in long-term survival, mortality rates among children requiring renal-replacement therapy remain substantially higher than those among children without end-stage renal disease. Increasing the proportion of children treated with renal transplantation rather than with dialysis can improve survival further. |
Keywords: | Australian and New Zealand Paediatric Nephrology Association Humans Kidney Failure, Chronic Renal Replacement Therapy Cause of Death Survival Rate Multivariate Analysis Proportional Hazards Models Risk Factors Cohort Studies Age Factors Adolescent Adult Child Child, Preschool Infant Survivors Australia New Zealand Female Male |
DOI: | 10.1056/NEJMoa031643 |
Published version: | http://dx.doi.org/10.1056/nejmoa031643 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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