Mortality in Children Treated With Maintenance Peritoneal Dialysis: Findings From the International Pediatric Peritoneal Dialysis Network Registry

Abstract Rationale & Objective Research on pediatric kidney replacement therapy (KRT) has primarily focused on Europe and North America. In this study, we aimed to describe the mortality risk of children treated with maintenance peritoneal dialysis (MPD) in different parts of the world and characterize the associated demographic and macro-economic factors. Study Design Prospective cohort study. Setting & Participants We evaluated patients aged Exposures The primary exposure was region (Asia, Western Europe, Eastern Europe, Latin America, North America, and Oceania). Other demographic, clinical and macro-economic (four income groups based on Gross National Income) factors were studied as exposures. Outcomes All-cause MPD mortality. Analytical Approach Patients were followed for three years. Mortality rates in different regions and income groups were calculated. Cause-specific hazards models with random effects were fit to calculate the proportional change in variance for factors that could explain variation in mortality rates. Results A total of 2,956 patients with a median age of 7.8 years at the start of KRT were included. After three years, the overall probability of death was 5%, ranging from 2% in North America to 9% in Eastern Europe. Mortality rates were higher in low-income countries than in high-income countries. Income category explained 50.1% of the variance in mortality risk between regions. Other explanatory factors included peritoneal dialysis modality at start (22.5%) and body mass index (11.1%). Limitations The interpretation of interregional survival differences as found in this study may be hampered by selection bias. Conclusion This study shows that the overall three-year patient survival on pediatric MPD is high, and that country income is associated with patient survival.