ESPN 50th Annual Meeting

ESPN 2017


 
All-cause mortality and cardiovascular disease incidence in patients with childhood-onset end-stage renal disease in Scotland
DINARA B. GALIYEVA 1 CAROLINE JACKSON 1 NYNKE HALBESMA 1 DAVID HUGHES 2 SUSAN BURNS 2 WENDY METCALFE 3 SARAH WILD 1

1- USHER INSTITUTE OF POPULATION HEALTH SCIENCES AND INFORMATICS, UNIVERSITY OF EDINBURGH, EDINBURGH, SCOTLAND;
2- ROYAL HOSPITAL FOR CHILDREN, GLASGOW, SCOTLAND
3- SCOTTISH RENAL REGISTRY
 
Introduction:

End-stage renal disease (ESRD) in children is a rare but serious health problem, which occurs in about 5 to 10 children per million each year, globally. Scottish Renal Registry (SRR) reports that the incidence of new renal replacement therapy (RRT) patients <20 years of age in Scotland in 2015 is 1.2 per 100.000 population. The major cause of mortality in children with ESRD is cardiovascular disease (CVD). Data on long-term survival and CVD incidence among children with ESRD are sparse. Available studies are short-term, are based on single centre experience and include only selected RRT population (either on dialysis, or after transplantation, or patients in specific age groups). Therefore, we aimed to describe the long-term survival and CVD incidence in patients initiating RRT in childhood in Scotland.

Material and methods:

We included all patients who started RRT at <18 years of age between 1961 and 2013 registered in the SRR to describe all-cause mortality (mortality cohort). We identified incident CVD through linkage to causes of death and hospital admission records. CVD incidence was defined as the first CV event, either CV death or CV hospital admission, whichever came first. Since causes of death and hospital admission data is available in Scotland from 1981 we included patients who started RRT between 1981 and 2013 to describe CVD incidence (CVD incidence cohort). We used Cox regression analysis to describe associations between primary renal disease (PRD), type of RRT, age at start of RRT and sex and all-cause mortality or CVD incidence. PRD were divided into three categories: congenital anomalies of kidney and urinary tract (CAKUT), glomerulonephritis and “other” (cystic kidney disease, hereditary nephropathy, ischemic renal failure, vasculitis and metabolic disorders). In the all-cause mortality analyses we included patients from the start of RRT until date of death or 31st December 2015, whichever came first. In the CVD incidence analysis we included patients from start of RRT until CVD event or 31st December 2015, whichever came first.

Results:

Characteristics of the mortality cohort (N=479) and the CVD incidence cohort (N=381) were similar. There were more males (57.2%) than females, the largest group of PRD was CAKUT (48.6%) and the majority of patients initiated their treatment with dialysis (87.9%). In the mortality cohort 126 patients died during a median follow-up of 18.3 years (interquartile range (IQR) 8.7-27.0). The long-term survival was 86% (95% CI 82.9-89.1) at 10 years and 76% (95% CI 72.2-79.8) at 20 years. In the CVD cohort 134 patients developed CVD incidence during a median follow-up of 12.9 years (IQR 5.6-21.5). The overall crude mortality and CVD incidence rates were 1.5 and 2.6 per 100 person-years, respectively. Patients with an ‘other’ category of PRD had a higher risk of all-cause mortality compared to patients with CAKUT. Receiving dialysis rather than a kidney transplantation during follow-up was associated with a higher risk of both all-cause mortality and CVD incidence. Younger age at initiation of RRT was associated with a higher risk of all-cause mortality, while the reverse was found with respect to CVD incidence.

Conclusions:

Type of RRT and age at start of RRT were significant determinants for both all-cause mortality and CVD incidence, while PRD was significantly associated only with all-cause mortality.