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Prolonged respiratory disorder predicts adverse prognosis in infants with end-stage kidney disease

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Abstract

Background

Among comorbidities, pulmonary hypoplasia (PH) is known as a significant risk factor for mortality in infants with end-stage kidney disease (ESKD). However, the final outcomes of infants with both ESKD and PH are still not well defined, as the diagnosis modality, and definition of PH severity remain ambiguous.

Methods

Children initiating peritoneal dialysis during infancy from 1990 to 2015 were followed until death, date of last contact, or the end of 2015. We examined the long-term outcome of children with congenital pulmonary disorders by studying infants with prolonged respiratory disorders of greater than 28 days duration after birth and evaluated risk factors for mortality.

Results

Forty-six children were followed (median follow-up, 9.23 years), and classified as children without (n = 38; Group A) or with (n = 8; Group B) a prolonged respiratory disorder. Overall actuarial 5 year survival rate in this cohort was 79.5 %. The survival curve in Group B showed a significant decline compared with Group A. Prolonged respiratory disorder was significantly associated with mortality by multivariate analysis (hazard ratio, 8.32).

Conclusions

Infants who initiate peritoneal dialysis complicated by prolonged respiratory disorders have increased adverse risk factors for mortality; therefore, withholding aggressive treatment should be considered.

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Acknowledgments

The authors would like to thank Mr. Tetsuji Kaneko (Department of Clinical Research, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan), Dr. Junya Hashimoto (Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan), Dr. Yoshinobu Nagaoka (Department of Pediatrics, National Hospital Organization, Hokkaido Medical Center), Dr. Hiroyuki Satoh (Department of Urology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan) and Dr. Seiichiro Shishido (Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan) for their contributions to the study.

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Authors and Affiliations

  1. Department of Pediatrics, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga, 520-2192, Japan

    Tomoyuki Sakai & Yusuke Okuda

  2. Department of Medical Statistics, Toho University Faculty of Medicine, Tokyo, Japan

    Yoshitaka Murakami

  3. Department of Nephrology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan

    Riku Hamada, Hiroshi Hataya & Masataka Honda

  4. Department of Pediatric Nephrology, Toho University Faculty of Medicine, Tokyo, Japan

    Yuko Hamasaki

  5. Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan

    Kenji Ishikura

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  1. Tomoyuki Sakai
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Correspondence to Tomoyuki Sakai.

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The authors declared that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by the Ethical Committee of Tokyo Metropolitan Children’s Medical Center (approval number: H24-96). For this type of study formal consent is not required.

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Sakai, T., Murakami, Y., Okuda, Y. et al. Prolonged respiratory disorder predicts adverse prognosis in infants with end-stage kidney disease. Pediatr Nephrol 31, 2127–2136 (2016). https://doi.org/10.1007/s00467-016-3430-5

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  • DOI: https://doi.org/10.1007/s00467-016-3430-5

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