ESPN 50th Annual Meeting

ESPN 2017

Karolis Azukaitis 1 Jitka Lachova 2 Aysun Bayazit 3 Ali Anarat 3 Nur Canpolat 4 Ali Duzova 5 Daniela Thurn 6 Mieczyslav Litwin 7 Anna Niemirska 7 Ipek Kaplan Bulut 8 Bruno Ranchin 11 Dusan Paripovic 12 Cengiz Candan 13 Jerome Harambat 14 Fatos Yalcinkaya 15 Rainer Büscher 16 Oguz Soylemezoglu 17 Osman Donmez 18 Sandra Habbig 19 Guido Laube 20 Ebru Yilmaz 21 Dorota Drozdz 22 Hakan Erdogan 23 Bettina Kranz 24 Rukshana Shroff 10 Anette Melk 6 Uwe Querfeld 25 Franz Schaefer 9

1- Clinic of Pediatrics, Vilnius University, Vilnius, Lithuania
2- University Hospital Motol, Prague, Czech Republic
3- Cukurova University, Adana, Turkey
4- Istanbul University Cerrahpasa, Istanbul, Turkey
5- Hacettepe University, Ankara, Turkey
6- Hannover Medical School, Hannover, Germany
7- The Children Memorial Health Institute, Warsaw, Poland
8- Ege University, Izmir, Turkey
9- Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
10- Great Ormond Street Hospital, London, UK
11- Hôpital Femme Mere Enfant, Lyon, France
12- University Children Hospital, Belgrade, Serbia
13- Göztepe Educational and Research Hospital, Istanbul, Turkey
14- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
15- Ankara University Faculty of Medicine, Ankara, Turkey
16- University Children Hospital Essen, Essen, Germany
17- Gazi University Hospital, Ankara, Turkey
18- Uludag University, Bursa, Turkey
19- University Children and Adolescent Hospital, Cologne, Germany
20- University Children Hospital Zurich, Zurich, Switzerland
21- Sanliurfa Children Hospital, Sanliurfa, Turkey
22- Jagiellonian University Medical College, Cracow, Poland
23- Dortcelik Children Hospital, Bursa, Turkey
24- University of Münster, Münster, Germany
25- Charité Children Hospital, Berlin, Germany

Hospitalizations are associated with significant psychosocial and economic burden. Whereas studies in adults have demonstrated an association between advancing CKD and increased risk of hospitalizations, information about the pediatric CKD population is scarce. We analyzed hospitalization burden in the 4C Study, a large European pediatric CKD cohort.

Material and methods:

Patients aged 6-17 years with CKD stage 3-5 or renal replacement therapy (RRT) followed at 55 centers in 14 countries with at least two study visits were included in the analysis. Data about CKD stage, RRT and hospitalizations were collected 6-monthly. Negative binomial regression model was used for multivariable analysis.


A total of 662 patients were followed for a total of 2718 patient-years (PY). Overall and non-elective hospitalization rates increased with advancing CKD and start of RRT (Figure). The same trend was observed for time spent in hospital (0.6, 0.75, 1.2, 6.1 and 9.9 days per PY in patients with CKD3, CKD4, CKD5, dialysis and renal transplant (Tx) recipients, respectively).  

In the multivariable analysis, RRT (IRR 6.64 and 5.3 for Tx; IRR 3.78 and 3.78 for dialysis, all p<0.0001; reference - CKD), presence of comorbidity (IRR 1.5 and 1.53, p=0.001) and younger age (IRR 0.92 and 0.93 per 1-yr increase, p<0.0001) but not renal diagnosis (p=0.59) were associated with higher overall and non-elective hospitalization rates, respectively. RRT (IRR 9.9 for Tx and IRR 7.43 for dialysis, both p<0.0001; reference - CKD) and younger age (IRR 0.92 per 1-yr increase, p=0.002) were also associated with higher number of days spent in hospital per PY. 



Advancing CKD, younger age and presence of comorbidities are associated with increased hospitalization burden in children with CKD.