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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 GettyImages-537645661 (1)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.

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