Children with end stage kidney disease (ESKD) face enormous health hurdles, and a significantly shorter life expectancy. But a recent report shows that the outcome of dialysis treatment they require is improving. 

In a study published in the May 8 issue of the Journal of the American Medical Association, Mark Mitsnefes, MD, MS, of the Division of Nephrology at Cincinnati Children’s and co-investigators from McGill University and Children’s Hospital of Philadelphia found that death rates among children and adolescents undergoing dialysis for ESKD in the United States have declined significantly over the past two decades.

For children whose kidney disease has progressed to end stage, kidney transplant remains the treatment of choice. But while they await transplant, dialysis is a life-saving therapy.

The researchers conducted a study to determine if all-cause, cardiovascular and infection-related death rates changed between 1990 and 2010 among patients younger than 21 with ESKD initially treated with dialysis.

They identified a total of 23,401 children and adolescents in the United States who began ESKD treatment with dialysis during those two decades, and noted a significant decrease in mortality rates among the patients over that time period.

Children under age 5 who started dialysis in 1990-1994 had a mortality rate of 112.2 per 1,000 person-years. For those who began dialysis in 2005-2010, the rate fell to 83.4 per 1,000 person-years. Among those 5 and older, the mortality rates declined from 44.6 per 1,000 person-years to 25.9 over the same time period. Significant decline occurred in both cardiovascular and infection-related mortality.

Although further research is needed to determine the factors responsible for the decrease, the investigators reported that “improved pre-dialysis care, advances in dialysis technology and greater experience of clinicians may each have played a role.”