Pediatric dialysis and renal transplantation in Kuwait over the past 11 years

Data on end-stage renal disease (ESRD) patients and their renal replacement therapy (RRT) were collected retrospectively from the three dialysis cente rs, the pediatric urology unit, and the organ transplant center of Kuwait. The study period was from 1 January 1986 to 31 December 1996. A total of 61 children, 50 of whom were Kuwaiti nationals, required RRT for ESRD during those 11 years. This gave an average annual incidence rate of 18 per millio n Kuwaiti children. Glomerulonephritis was the most-frequent underlying dis ease and accounted for 44% of total cases, while pyelonephritis (including urinary tract anomalies and dysplastic kidneys) was responsible for 30%, Mu ltisystem disease was responsible for ESRD in 7 patients (14%), 2 of whom h ad lupus nephritis, 2 vasculitis, 2 Henoch-Schonlein purpura, and 1 hemolyt ic uremic syndrome. Continuous ambulatory peritoneal dialysis and home inte rmittent peritoneal dialysis, using cycler machines, were not favored dialy sis techniques by most parents, especially for those <6 years old. The actu arial survival on dialysis was 75%+/-7% at 12 months. Of the 8 patients who died, 7 were <6 years old. Thirty-eight patients received 46 kidney transp lants, 13 of which were performed on a pre-emptive basis. The actuarial pat ient survivals at 12 months for those receiving first live and cadaveric ki dney transplants were 90%+/-5% and 85%+/-2%, respectively, while those for grafts were 76%+/-8% and 66%+/-2%, respectively. This is the first nationwi de longterm study of the incidence and etiology of pediatric ESRD in our ar ea and the RRT in a country with adequate treatment facilities.