Adult Outcomes After Childhood KRT 

Little research has focused on young adults who began kidney replacement therapy (KRT) during childhood. However, this complex population should interest nephrologists as they will transition to adult renal centers as they move into adulthood. Therefore, Iris R. Montez de Sousa and colleagues wanted to describe the characteristics, treatment history, graft survival, and patient survival of these patients, and to report their five-year prognosis and expected remaining lifespan. 

The researchers utilized data from the European Renal Association Registry on patients who reached age 18 from 2008 to 2019. The data included 2,944 patients from 21 countries. Patient characteristics and treatment trajectories were assessed before and after patients reached 18 years. Kaplan-Meier and Cox proportional hazards regression were used to conduct patient and graft survival analyses.  

The unadjusted five-year patient survival rate was 96.9% (95% CI, 96.2-97.5). The percentage of adult survivors starting KRT at age 0-4 years and having preemptive kidney transplantation increased. There was a higher risk of death among patients on dialysis compared to transplant recipients (adjusted HR, 5.44; 95% CI, 3.34-8.86).  

Between ages 18 and 23 years, 34% of dialysis patients continued the treatment, while about 21% of the transplant recipients lost their transplants. The life expectancy of transplant recipients and dialysis patients at age 18 years was 17 and 40 years shorter, respectively, compared to that of the general population. 

In summary, although life expectancy was shorter for kidney transplant recipients at age 18 compared to the general population, those with a functioning kidney graft at age 18 fared better than patients on dialysis. Unfortunately, however, about one-fifth of grafts failed between ages 18 and 23 years, and one-third of patients remained on dialysis. 

Source: Nephrology Dialysis Transplantation.