Risk factors for mortality in infants and young children on dialysis

The factors associated with a greater mortality risk in infants and young c hildren undergoing dialysis have not been clearly determined. We report the results of a North American Pediatric Renal Transplant Cooperative Study d esigned to assess risk factors in patients aged younger than 6 years at ini tiation of dialysis therapy. Sixty-four nonsurvivors were matched with 110 survivors for age at dialysis initiation, primary renal disease, and year o f entry onto the database. Questionnaires on 137 patients (51 nonsurvivors, 86 survivors) were completed by participating centers. Seventy-five percen t (103 of 137 patients) of the patients were aged younger than 2 years at d ialysis initiation; 42% (58 of 137 patients) had renal aplasia, dysplasia, and/or hypoplasia or obstructive uropathy; 62% were boys; and 62% were whit e. One-year patient survival rates were 83% in infants beginning dialysis a t younger than 3 months of age, 89% in 3- to 23-month-olds, and 95% in 2- t o 5-year-olds (P = 0.001). Comorbid nonrenal disease occurred in 37 of 51 n onsurvivors (74%) versus 46 of 84 survivors (55%; P = 0.027). Nonsurvivors had pulmonary disease and/or hypoplasia more often (14 of 37 nonsurvivors; 37.8% versus 8 of 46 survivors; 17.4%; P = 0.04). Oliguria or anuria was pr esent in 23 of 33 nonsurvivors (70%) aged younger than 2 years versus 26 of 84 survivors (41%; P = 0.007). Infection accounted for 15 of 51 deaths (29 .4%). In summary, these results suggest that age at dialysis initiation; pr esence of nonrenal disease, particularly pulmonary disease and/or hypoplasi a; and oliguria or anuria in children aged younger than 2 years are identif iable as risk factors for mortality in these young patients. (C) 2001 by th e National Kidney Foundation, Inc.