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Alhasan K, Alsalmi AA, Almaiman W, Al Herbish AJ, Farhat A, Sandokji I, Aloufi M, Faqeehi HY, Abdulmajeed N, Alanazi A, AlHassan A, Alshathri A, Almalki AM, Bafageeh AA, Aldajani AM, AlMuzain A, Almuteri FS, Nasser HH, Al Alsheikh K, Almokali KM, Maghfuri M, Abukhatwah MW, Ahmed MAM, Fatani N, Al-Harbi N, AlDhaferi RF, Amohaimeed S, AlSannaa ZH, Shalaby MA, Raina R, Broering DC, Kari JA, Temsah MH. Insight into prevalence, etiology, and modalities of pediatric chronic dialysis: a comprehensive nationwide analysis. Pediatr Nephrol 2024; 39:1559-1566. [PMID: 38091245 DOI: 10.1007/s00467-023-06245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND This study aimed to determine the prevalence and etiology of kidney failure (KF) among children below 15 years of age receiving chronic dialysis in Saudi Arabia and describe their dialysis modalities. METHODS This cross-sectional descriptive study was conducted on 8 August 2022, encompassing all 23 pediatric dialysis centers in Saudi Arabia. Data gathered comprised patient demographics, causes of KF, and the dialysis methods employed. Collected data underwent analysis to determine prevalence of children undergoing chronic dialysis, discern underlying causes of KF, and evaluate distribution of patients across different dialysis modalities. RESULTS The prevalence of children on chronic dialysis is 77.6 per million children living in Saudi Arabia, equating to 419 children. The predominant underlying cause of KF was congenital anomalies of the kidneys and urinary tract (CAKUT), representing a substantial 41% of cases. Following this, others or unknown etiologies accounted for a noteworthy 25% of cases, with focal segmental glomerulosclerosis (FSGS) comprising 13%, glomerulonephritis at 11%, and congenital nephrotic syndrome contributing 10% to etiological distribution. Regarding dialysis modalities employed, 67% of patients were on peritoneal dialysis (PD), while the remaining 33% were on hemodialysis (HD). CONCLUSIONS This first nationwide study of pediatric chronic dialysis in Saudi Arabia sheds light on the prevalence of children undergoing chronic dialysis and underlying causes of their KF, thereby contributing to our understanding of clinical management considerations. This research serves as a stepping stone for the development of national registries.
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Affiliation(s)
- Khalid Alhasan
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Amro Attaf Alsalmi
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Weiam Almaiman
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Adi J Al Herbish
- Pediatric Nephrology Division, Pediatric Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Afrah Farhat
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Sandokji
- Section of Nephrology, Department of Pediatrics, College of Medicine, Taibah University, Medina, Saudi Arabia
| | - Majed Aloufi
- Pediatric Nephrology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Yahya Faqeehi
- Division of Pediatric Nephrology, King Fahad Medical City, Children Specialized Hospital, Riyadh, Saudi Arabia
| | - Naif Abdulmajeed
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Nephrology, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Pediatric Nephrology Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulkarim Alanazi
- Division of Pediatric Nephrology, King Fahad Medical City, Children Specialized Hospital, Riyadh, Saudi Arabia
| | - Abdulaziz AlHassan
- Pediatric Department, Maternity and Children Hospital, Ministry of Health, Al Ahsa, Saudi Arabia
| | - Abdulaziz Alshathri
- Pediatric Nephrology Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abeer Mohammad Almalki
- Pediatric Nephrology Department, Children's Hospital, Ministry of Health, Taif, Saudi Arabia
| | - Afaf Alawi Bafageeh
- Center of Multi-Organ Transplant, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ali M Aldajani
- Pediatric Nephrology Department, Maternity Children Hospital, Dammam, Saudi Arabia
| | - Ashraf AlMuzain
- Pediatric Department, King Fahd Hospital of the University, Khobar, Saudi Arabia
| | - Faten Sudan Almuteri
- Pediatric Nephrology Division, Pediatric Department, King Salman Bin Abdulaziz Medical City, Ministry of Health, Madina, Saudi Arabia
| | - Haydar Hassan Nasser
- Division of Nephrology, Pediatric Department, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khalid Al Alsheikh
- Pediatric Department, Maternity and Children Hospital, Abha, Saudi Arabia
| | - Khamisa Mohamed Almokali
- Pediatric Nephrology Division, Pediatric Department, King Abdullah Specialized Children Hospital, Ministry of National Guard, Riyadh, Saudi Arabia
| | - Magbul Maghfuri
- Pediatric Nephrology Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Mohamed Waleed Abukhatwah
- Pediatric Nephrology Section, Pediatric Department, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | | | - Naeima Fatani
- Pediatric Department, Maternity and Childcare Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Naffaa Al-Harbi
- Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Jeddah, Saudi Arabia
| | - Rezqah Fajor AlDhaferi
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Sulaiman Amohaimeed
- Pediatric Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Mohamed A Shalaby
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Nephrology Centre of Excellence, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rupesh Raina
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Dieter Clemens Broering
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Jameela A Kari
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Nephrology Centre of Excellence, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Evidence-Based Healthcare and Knowledge Translation Research Chair, King Saud University, Riyadh, Saudi Arabia.
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Roca-Tey R, Ariceta G, Ríos H, Cruz A, Comas J, Tort J. Changes in vascular access profile for pediatric hemodialysis patients over time: A registry-based study from Catalonia. J Vasc Access 2023:11297298231202634. [PMID: 37817674 DOI: 10.1177/11297298231202634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND The criteria for vascular access (VA) selection in pediatric hemodialysis (HD) population has changed over time until the current patient-centered approach using the individualized Life-Plan. We analyzed the type of VA used by incident and prevalent end-stage kidney disease (ESKD) pediatric patients (pts) treated with HD in Catalonia. METHOD Data from the Catalan Renal Registry of ESKD pts under 18 years of age undergoing kidney replacement therapy (KRT) were examined for a 22-year period (1997-2018). RESULTS ESKD children starting KRT through HD decreased progressively from 55.6% (1997-2001) to 38.2% (2012-2018) and, conversely, there was an increase in pts starting KRT by preemptive kidney transplantation (KT) from 28.9% to 42.6% between the same periods (for both comparisons, p = 0.007). Most ESKD pts started HD by fistula (AVF) from 1997 to 2001 (56.5%) but this percentage decreased over time and no AVFs were used to start HD in children from 2012 to 2018. Likewise, the percentage of children starting HD by tunneled catheter increased progressively from 8.7% to 72.2% between the same periods (for both comparisons, p < 0.001). Regarding prevalent ESKD pts, children on HD decreased from 34.9% in 1997 to 4.7% in 2018 and, conversely, pts with a functioning kidney graft increased from 62.8% to 92.4% during the same periods (for both comparisons, p < 0.001). There was a progressive decrease in the percentage of children dialyzed by AVF from 100% in 1997 to 0% in 2018 (p < 0.001). The KT rate increased from 5.4 per million population (pmp) in 1997 to 17.1 pmp in 2018 (p = 0.007). The median time on HD prior to the first KT progressively decreased to 6.6 months (2014-2018). CONCLUSION The high KT rate was a determining factor in choosing the VA type in the incident and prevalent pediatric population treated with HD in Catalonia.
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Affiliation(s)
- Ramon Roca-Tey
- Department of Nephrology, Hospital Universitari Mollet, Fundació Sanitària Mollet, Mollet del Vallès, Barcelona, Spain
| | - Gema Ariceta
- Department of Pediatric Nephrology, Hospital Universitari Vall d' Hebron, Barcelona, Spain
- Department of Pediatrics, Autonomous University of Barcelona, Barcelona, Spain
| | - Héctor Ríos
- Department of Pediatric Nephrology, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Alejandro Cruz
- Department of Pediatric Nephrology, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Jordi Comas
- Organització Catalana de Transplantaments (OCATT), Health Department of Catalonia, Barcelona, Spain
| | - Jaume Tort
- Organització Catalana de Transplantaments (OCATT), Health Department of Catalonia, Barcelona, Spain
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Ku E, McCulloch CE, Bicki A, Lin F, Lopez I, Furth SL, Warady BA, Grimes BA, Amaral S. Association Between Dialysis Facility Ownership and Mortality Risk in Children With Kidney Failure. JAMA Pediatr 2023; 177:1065-1072. [PMID: 37669042 PMCID: PMC10481326 DOI: 10.1001/jamapediatrics.2023.3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/13/2023] [Indexed: 09/06/2023]
Abstract
Importance In adults, treatment at profit dialysis facilities has been associated with a higher risk of death. Objective To determine whether profit status of dialysis facilities is associated with the risk of death in children with kidney failure treated with dialysis and whether any such association is mediated by differences in access to transplant. Design, Setting, and Participants This retrospective cohort study reviewed US Renal Data System records of 15 359 children who began receiving dialysis for kidney failure between January 1, 2000, and December 31, 2019, in US dialysis facilities. The data analysis was performed between May 2, 2022, and June 15, 2023. Exposure Time-updated profit status of dialysis facilities. Main Outcomes and Measures Adjusted Fine-Gray models were used to determine the association of time-updated profit status of dialysis facilities with risk of death, treating kidney transplant as a competing risk. Cox proportional hazards regression models were also used to determine time-updated profit status with risk of death regardless of transplant status. Results The final cohort included 8465 boys (55.3%) and 6832 girls (44.7%) (median [IQR] age, 12 [3-15] years). During a median follow-up of 1.4 (IQR, 0.6-2.7) years, with censoring at transplant, the incidence of death was higher at profit vs nonprofit facilities (7.03 vs 4.06 per 100 person-years, respectively). Children treated at profit facilities had a 2.07-fold (95% CI, 1.83-2.35) higher risk of death compared with children at nonprofit facilities in adjusted analyses accounting for the competing risk of transplant. When follow-up was extended regardless of transplant status, the risk of death remained higher for children treated in profit facilities (hazard ratio, 1.47; 95% CI, 1.35-1.61). Lower access to transplant in profit facilities mediated 67% of the association between facility profit status and risk of death (95% CI, 45%-100%). Conclusions and Relevance Given the higher risk of death associated with profit dialysis facilities that is partially mediated by lower access to transplant, the study's findings indicate a need to identify root causes and targeted interventions that can improve mortality outcomes for children treated in these facilities.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Alexandra Bicki
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Isabelle Lopez
- Division of Nephrology, Department of Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Susan L. Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bradley A. Warady
- Children’s Mercy Kansas City, Division of Nephrology, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Barbara A. Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Sandra Amaral
- Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Ahn YH. Optimal hemodialysis treatment for pediatric kidney failure patients. Clin Exp Pediatr 2023; 66:125-126. [PMID: 36789490 PMCID: PMC9989721 DOI: 10.3345/cep.2022.01431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/17/2022] [Indexed: 02/16/2023] Open
Affiliation(s)
- Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.,Kidney Research Institute, Medical Research Center, Seoul National University College of Medicine, Seoul, Korea
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Raina R, Abu-Arja R, Sethi S, Dua R, Chakraborty R, Dibb JT, Basu RK, Bissler J, Felix MB, Brophy P, Bunchman T, Alhasan K, Haffner D, Kim YH, Licht C, McCulloch M, Menon S, Onder AM, Khooblall P, Khooblall A, Polishchuk V, Rangarajan H, Sultana A, Kashtan C. Acute kidney injury in pediatric hematopoietic cell transplantation: critical appraisal and consensus. Pediatr Nephrol 2022; 37:1179-1203. [PMID: 35224659 DOI: 10.1007/s00467-022-05448-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/15/2022]
Abstract
Hematopoietic cell transplantation (HCT) is a common therapy for the treatment of neoplastic and metabolic disorders, hematological diseases, and fatal immunological deficiencies. HCT can be subcategorized as autologous or allogeneic, with each modality being associated with their own benefits, risks, and post-transplant complications. One of the most common complications includes acute kidney injury (AKI). However, diagnosing HCT patients with AKI early on remains quite difficult. Therefore, this evidence-based guideline, compiled by the Pediatric Continuous Renal Replacement Therapy (PCRRT) working group, presents the various factors that contribute to AKI and recommendations regarding optimization of therapy with minimal complications in HCT patients.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
| | - Rolla Abu-Arja
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sidharth Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | - Richa Dua
- Monmouth Medical Center, Long Branch, NJ, USA
| | - Ronith Chakraborty
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - James T Dibb
- Department of Internal Medicine, Summa Health System - Akron Campus, Akron, OH, USA
| | - Rajit K Basu
- Children's Healthcare of Atlanta, Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - John Bissler
- Department of Pediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA
| | - Melvin Bonilla Felix
- Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Patrick Brophy
- Department of Pediatrics, University of Rochester School of Medicine, Rochester, NY, USA
| | - Timothy Bunchman
- Pediatric Nephrology & Transplantation, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Khalid Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Yap Hui Kim
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Christopher Licht
- Division of Nephrology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Shina Menon
- Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Ali Mirza Onder
- Division of Pediatric Nephrology, Le Bonheur Children's Hospital, University of Tennessee, School of Medicine, Memphis, TN, USA
- Division of Pediatric Nephrology, Batson Children's Hospital of Mississippi, University of Mississippi Medical Center, Jackson, MS, USA
| | - Prajit Khooblall
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Amrit Khooblall
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - Veronika Polishchuk
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hemalatha Rangarajan
- Division of Hematology, Oncology, Blood and Bone Marrow Transplant, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Azmeri Sultana
- Department of Pediatric Nephrology, MR Khan Hospital & Institute of Child Health, Mirpur-2, Dhaka, Bangladesh
| | - Clifford Kashtan
- Department of Pediatrics, Division of Pediatric Nephrology, University of Minnesota Medical School, Minneapolis, MN, USA
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Abstract
Pediatric hemodialysis access is a demanding field. Procedures are infrequent, technically challenging, and associated with high complication and failure rates. Each procedure affects subsequent access and transplants sites. The choice is made easier and outcomes improved when access decisions are made by a multidisciplinary, pediatric, hemodialysis access team. This manuscript reviews the current literature and offers technical suggestions to improve outcomes.
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