Comorbidities in chronic pediatric peritoneal dialysis patients
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Comorbidities in chronic pediatric peritoneal dialysis patients : a report of the International Pediatric Peritoneal Dialysis Network. / Neu, Alicia M; Sander, Anja; Borzych-Duzalka, Dagmara; Watson, Alan R; Vallés, Patricia G; Ha, Il Soo; Patel, Hiren; Askenazi, David; Balasz-Chmielewska, Irena; Lauronen, Jouni; Groothoff, Jaap W; Feber, Janusz; Schaefer, Franz; Warady, Bradley A; IPPN investigators; Kemper, Markus Josef.
in: PERITON DIALYSIS INT, Jahrgang 32, Nr. 4, 2012, S. 410-8.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Comorbidities in chronic pediatric peritoneal dialysis patients
T2 - a report of the International Pediatric Peritoneal Dialysis Network
AU - Neu, Alicia M
AU - Sander, Anja
AU - Borzych-Duzalka, Dagmara
AU - Watson, Alan R
AU - Vallés, Patricia G
AU - Ha, Il Soo
AU - Patel, Hiren
AU - Askenazi, David
AU - Balasz-Chmielewska, Irena
AU - Lauronen, Jouni
AU - Groothoff, Jaap W
AU - Feber, Janusz
AU - Schaefer, Franz
AU - Warady, Bradley A
AU - IPPN investigators
AU - Kemper, Markus Josef
PY - 2012
Y1 - 2012
N2 - UNLABELLED: BACKGROUND, OBJECTIVES, AND METHODS: Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality.RESULTS: Information on comorbidities was available for 1830 patients 0 - 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 - 80.9 months), and total follow-up time in the registry was 2095 patient-years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001).CONCLUSIONS: Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple comorbidities were frequently reported among patients with a defined syndrome. Preliminary analysis suggests an association between comorbidity and poor outcome in those patients. As this powerful international registry matures, further multivariate analyses will be important to more clearly define the impact of comorbidities on hospitalization rates and mortality in pediatric CPD patients.
AB - UNLABELLED: BACKGROUND, OBJECTIVES, AND METHODS: Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality.RESULTS: Information on comorbidities was available for 1830 patients 0 - 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 - 80.9 months), and total follow-up time in the registry was 2095 patient-years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001).CONCLUSIONS: Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple comorbidities were frequently reported among patients with a defined syndrome. Preliminary analysis suggests an association between comorbidity and poor outcome in those patients. As this powerful international registry matures, further multivariate analyses will be important to more clearly define the impact of comorbidities on hospitalization rates and mortality in pediatric CPD patients.
KW - Adolescent
KW - Child
KW - Child, Preschool
KW - Chronic Disease
KW - Comorbidity
KW - Female
KW - Follow-Up Studies
KW - Hospitalization
KW - Humans
KW - Infant
KW - Kidney Failure, Chronic
KW - Male
KW - Peritoneal Dialysis
KW - Prevalence
KW - Registries
KW - Survival Analysis
U2 - 10.3747/pdi.2012.00124
DO - 10.3747/pdi.2012.00124
M3 - SCORING: Journal article
C2 - 22859841
VL - 32
SP - 410
EP - 418
JO - PERITON DIALYSIS INT
JF - PERITON DIALYSIS INT
SN - 0896-8608
IS - 4
ER -