CAUSE OF DEATH FOR CHILDREN ON CHRONIC DIALYSIS - A 20-YEAR ANALYSIS

We conducted a retrospective chart review to determine the immediate c ause of death, the life expectancy, and comorbid factors associated wi th chronic dialysis in children. Materials used included hospital and dialysis charts, biopsy and post-mortem reports, and death certificate s. The review spanned the period July 1972 through June 1999 and inclu ded 291 children who received a total of 6,614 patient-months of chron ic dialysis. Twenty-two deaths occurred during the study period: 13 in the hemodialysis (HD) group and nine in the peritoneal dialysis (PD) group. The most common immediate causes of death were systemic infecti on (n = 12) and bleeding complications (n = 5). The majority of the mo rbid infections were caused by fungi and Gram-negative bacteria. The m orbid bleeding complications were intra-abdominal (n=2), cerebral (n=2 ), and pericardial (n=1). Chronic conditions which contributed to pati ent fatality included pancytopenia, encephalopathy, and congestive hea rt failure. We found that the mortality rate for children on chronic d ialysis is almost 80 times greater than for the normal pediatric popul ation. The greatest risk of dying is during the first year of dialysis . Infection is the leading cause of death. There was no statistical di fference in survival between HD patients and PD patients. Survival on dialysis was directly related to age, with infants on dialysis having poorer survival than adolescents. Overall, survival of children on dia lysis was similar to survival with renal transplantation.