MORTALITY TRENDS IN PEDIATRIC-PATIENTS WITH CHRONIC-RENAL-FAILURE

Mortality trends were analyzed in 441 children and adolescents with ch ronic renal failure (CRF) observed over a 24-year period before and af ter institution of renal replacement therapy (RRT). A total of 93 pati ents died. Overall mortality rate (MR) per 100 patient years decreased from 6.6 in 1969-1978 to 2.5 in 1979-1988 and increased slightly to 2 .9 in 1989-1992. The fall involved all four modes of treatment: conser vative, hemodialysis (HD), continuous peritoneal dialysis (CPD), and t ransplantation (TX). From 1979-1988 to 1989-1992 MR on conservative an d on dialysis treatment changed only slightly and was similar on HD an d CPD. An alarming rise in MR was noted after TX in 1989-1992, mainly due to malignant tumors. In 44 patients who died on conservative treat ment, the reasons for non-acceptance for RRT were analyzed: in 22 mult i-morbidity was the main reason, usually because of a congenital neuro logical disorder. Some patients died from advanced uremia or unexpecte d events after the decision to institute RRT. Our experience demonstra tes a persistent mortality in pediatric patients with CRF, which in re cent years is primarily ascribed to congenital multi-morbid conditions which make RRT unfeasible, infections on dialysis treatment, and mali gnancies after TX.