ESPN 50th Annual Meeting

ESPN 2017


 
CAUSES OF NON-ELECTIVE HOSPITALIZATIONS IN CHILDREN WITH CHRONIC KIDNEY DISEASE (CKD): FINDINGS FROM THE 4C STUDY
Jitka Lachova 1 Karolis Azukaitis 24 Aysun Bayazit 2 Ali Anarat 2 Nur Canpolat 3 Lale Sever 3 Ali Duzova 4 Daniela Thurn 5 Nurdan Yildiz 6 Onder Yavascan 7 Bruno Ranchin 8 Cengiz Candan 9 Jerome Harambat 10 Fatos Yalcinkaya 11 Rainer Büscher 12 Oguz Soylemezoglu 13 Osman Donmez 14 Sandra Habbig 15 Guido Laube 16 Ebru Yilmaz 17 Dorota Drozdz 18 Hakan Erdogan 19 Bettina Kranz 20 Rukshana Shroff 21 Anette Melk 5 Uwe Querfeld 22 Franz Schaefer 23

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

CKD and renal replacement therapy (RRT) are associated with an increased risk for non-elective hospitalizations. The causes for hospitalizations in the pediatric CKD population have not been defined to date. Here, we aimed to analyze the leading reasons for non-elective hospitalizations in the 4C study, a large prospective European cohort of children with CKD.

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, renal replacement therapy (RRT) and hospitalizations were collected 6-monthly.

Results:

A total of 662 patients were followed for a total of 2718 patient-years (PY). A total of 138, 80 and 167 non-elective hospitalizations were documented for patients on conservative therapy (CKD; n=662), dialysis (n=170) and renal transplant (RTx) recipients (n=205), respectively.
The leading causes for non-elective hospitalizations in all groups were infections (44.2%, 44.5% and 48.5% in patients on CKD, dialysis and RTx, respectively). These were followed by non-infectious gastrointestinal conditions (17.4%) in patients on CKD, cardiovascular complications (17.5%; 64.3% hypertension) in patients on dialysis and RTx rejection-related hospitalizations (28.7%) in RTx recipients. Urinary tract infections (UTI) accounted for most of infection-related hospitalization in children on CKD, HD and RTx (62.3%, 35.7% and 44.4%) and peritonitis was the leading cause in patients on PD (62.5%). EBV or CMV infections comprised 13.6% of infection related hospitalizations in RTx.

Conclusions:

Infectious diseases represent the leading cause for non-elective hospitalizations in children with CKD and on any RRT. UTIs are the major cause for hospitalizations in most children with CKD. Among patients on RRT, children on PD are at highest risk for hospitalizations due to treatment modality-related infections.