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Kidney Week

Abstract: SA-PO657

Hospitalization in Children: Experience of the Italian Registry of Pediatric Dialysis

Session Information

  • Pediatric Nephrology - 2
    October 26, 2024 | Location: Exhibit Hall, Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology

Authors

  • La Porta, Edoardo, Istituto Giannina Gaslini, Genova, Liguria, Italy
  • Spagnol, Rachele, Universita degli Studi di Padova Scuola di Medicina e Chirurgia, Padova, Veneto, Italy
  • Conversano, Ester, Ospedale Pediatrico Bambino Gesu, Roma, Italy
  • Vidal, Enrico, Universita degli Studi di Padova Scuola di Medicina e Chirurgia, Padova, Veneto, Italy
Background

Children in dialysis experience complications leading to hospitalizations. This nationwide retrospective observational study, performed within the Italian Registry of Pediatric Chronic Dialysis (IRPCD), aims to describe complications in children on chronic dialysis and to compare hospitalization rates between dialysis modalities

Methods

Pediatric patients receiving HD or PD were recorded from 2000 to 2019 by the IRPCD. Hospitalization was defined as an admission involving at least one overnight stay, excluding hospitalizations for dialysis initiation and kidney transplantation. Reasons for hospitalization were categorized into infections related to dialysis, non-infectious complications related to dialysis, other infections, other non-infectious conditions, diagnostic tests, procedures or surgery, and other complications

Results

847 incident dialysis patients (493 PD, 354 HD) were enrolled. The median age at dialysis initiation was 5 (1.0-10.7) years for PD and 13 (9.6-15.3) years for HD, females in both groups (59.6% and 54.8%). The primary cause of ESKD was CAKUT in both groups (41.6% in PD, 32% in HD); a significant difference was noted for glomerulonephritis, with a higher prevalence in the HD group (25.4 vs. 16.1%).
Of the 847 patients, 418 (49.3%) required hospitalization, predominantly in the PD group (314 [75%] vs. 104 [24%] in HD ). Median hospitalization duration was 6 days in HD (IQR 4.5-11) and PD (4-9) patients. Infections related to dialysis were the main cause of hospitalization (35%), followed by other non-infectious medical conditions (18%) and other ESKD-related complications (14%).
The hazard of hospitalization over time was significantly lower for HD compared to PD patients (aHR 0.54[0.42;0.70]) and it decreased with increasing patient age (aHR 0.97[0.95;0.98]) and calendar year since dialysis initiation (aHR 0.97[0.96;0.98]). The hazard of hospitalization was not related to the primary renal disease but increased significantly with the number of complications. Children on PD for over 1 year had a higher aHR (1, ref) for changing treatment compared to HD patients (0.29[0.10;0.81])

Conclusion

The risk of hospitalization is linked to younger age at dialysis initiation and decreases in more recent calendar years. Children on PD face a higher risk of hospitalization resulting in a higher chance of switching dialysis modality.