ESRD Among Children, Adolescents and Young Adults
By Susan Eymann, MS11 Sep 2019
(Gleaned from the 2018 USRDS Annual Data Report: Volume II: Chapter 7)
In children, adolescents and young adults, end-stage renal disease (ESRD) is caused by both congenital and acquired disorders. A majority of children with ESRD will depend on the spectrum of the available renal replacement therapies throughout their lifetime, including hemodialysis, peritoneal dialysis and transplantation. Throughout their ESRD experience, children are at risk for failure to grow, frequent hospitalizations, and significantly higher mortality than the general pediatric population. Hospitalizations due to medical or surgical indications are a particular burden to the ESRD population.
- The number of children and adolescents beginning end-stage renal disease (ESRD) care decreased 21% from a high of 17.5 per million in 2004 to 13.8 per million population (PMP) in 2016.
- At the end of 2016, the prevalence of children and adolescents (0 to 21 years of age) with ESRD was 9,721, or 99.1 per million population (PMP).
- Over the last decade, the one-year ESRD patient mortality decreased by 20.4%, with the greatest improvement observed in the 0-4-year age group which experienced a 35.0% decrease in mortality.
- Of the 9,619 children and adolescents under 22 years of age with prevalent ESRD at the end of 2016, kidney transplant was the most common ESRD modality (6,927, 72.0%), followed by HD (1,651, 17.2%) and PD (1,019, 10.6%).
- 36.3% of children received a kidney transplant within their first year of ESRD care. In 2016, 1,020 children received a kidney transplant, 35.7% from living donors.
- Since 1978, a total of 19,441 survivors of childhood-onset ESRD have transitioned into adulthood and 81% of these individuals were still alive as of December 31, 2016
- Peritoneal dialysis is used more often in young children than adults. However, children initiate ESRD therapy with HD more frequently than PD or transplantation. In 2016, 51.2% initiated therapy with HD, 25.7% with PD, and 20.0% with a transplant.