Pediatric maintenance peritoneal dialysis mortality rate linked to country income
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A registry study of children undergoing maintenance peritoneal dialysis worldwide shows an overall mortality rate of 5% after 3 years, with higher mortality rates in low-income countries.
“Income category explained 50.1% of the variance in mortality risk between regions,” Sophie Ploos van Amstel, MD, of the University of Amsterdam, and colleagues wrote. “Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%).”
Although most epidemiological research into kidney replacement therapy in children has focused on Europe and North America, the investigators wrote that “62.5% of children undergoing chronic dialysis live in other parts of the globe.”
Therefore, the investigators conducted a prospective cohort study of 2,956 patients younger than19 years of age at the time of registration in the International Pediatric Peritoneal Dialysis Network who initiated maintenance peritoneal dialysis between 1996 and 2017.
Researchers categorized patients by region (Asia, Europe, Latin America, North America and Oceania) and gross national income (GNI) and divided countries into low-, lower-middle, upper-middle and high-income groups to describe the potential relationship between patients’ mortality risk and different demographic and macro-economic factors.
Researchers coded confirmed genetic disorders and comorbidities, including cardiac abnormalities (14.1%), cognitive dysfunction (13.8%) and motor dysfunction (11.7%). Excluding hearing dysfunction, they found North America had the most reported cases of comorbidities.
The investigators found low-income countries, particularly those in Eastern Europe and Latin America reported the highest infection-related deaths. Cumulative incidence competing risks analysis supported the data and showed patients in countries with a GNI of less than $28,000 had a higher mortality risk and lower probability of kidney transplant surgery than patients from counties with a GNI exceeding $28,000.
According to the researchers, limitations of the study included inaccuracies and possible low-quality data from online registration databases and assumed mortality reports in developing counties.
“The interpretation of interregional survival differences as found in this study remains complicated due to selection bias working in different directions. To reduce such bias, population-based registries are warranted,” the researchers wrote.
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Ploos van Amstel S, et al. Am J Kidney Dis. 2020;doi:https://doi.org/10.1053/j.ajkd.2020.11.031.
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