In children with end-stage renal disease (ESRD), a higher estimated glomerular filtration rate (eGFR) at dialysis initiation is associated with lower survival, particularly when the initial treatment modality is haemodialysis, suggests a new study in the Journal of the American Society of Nephrology.
Researchers performed a retrospective cohort study of patients aged one to 18 years who commenced dialysis between 1995 and 2015 to explore the impact of timing of dialysis initiation on survival benefit in children. The primary predictor was eGFR at the time of dialysis initiation: higher (eGFR >10 mL/min/1.73 m2) versus lower eGFR (eGFR ≤10 ml/min/1.73 m2).
Of 15,170 children, 4,327 had a higher eGFR (median eGFR, 12.8 mL/min/1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 mL/min/1.73 m2), those with a higher eGFR at dialysis initiation were more often white, female, underweight or obese, and more likely to have glomerulonephritis as the cause of ESRD.
The risk of death was 1.36 times higher among children with a higher (versus lower) eGFR at dialysis initiation.
The association between timing of dialysis and poorer survival differed by treatment modality, being stronger among children initially treated with haemodialysis (hazard ratio [HR] 1.56) versus peritoneal dialysis (HR 1.07).