4 - Characterizing Risk Factors for the need for Kidney Replacement Therapy in Children after Discontinuation of Maintenance Dialysis

Poster Number: 4
Publication Number: 4.2060

Background: Only 4% of children receiving outpatient dialysis recover sufficient function to discontinue dialysis but little is known regarding risk factors associated with the need to restart dialysis or undergo kidney transplantation after recovery.

Objective: To identify factors associated with the need for kidney replacement therapy after kidney recovery (defined as discontinuation of outpatient maintenance dialysis ≥ 90-day) in children residing in the U.S.

Design/Methods: Using the United States Renal Data System, we performed a retrospective cohort study of children < 18 years old who received maintenance dialysis between 1996-2019. We compared characteristics of children who needed to restart dialysis or undergo kidney transplantation and identified risk factors associated with restarting dialysis within 3 years after kidney recovery using Cox proportional hazards models.

Results: 808 children were included. Median age was 11 years (IQR 1-15), 55% were female, and 45% were Non-Hispanic White (NHW) children. 42% of children in the cohort did not require kidney replacement therapy, 44% restarted dialysis, and 14% had kidney transplant over a mean follow-up of 42 months. Dialysis was restarted in nearly half of children ≥1 years old (47% 1-4yr, 47% 5-12yr, 49% 13-17yr, p< 0.001), half of the Hispanic and Non-Hispanic Black (NHB) children (51% Hispanic children, 53% NHB children, p< 0.001). More NHW children (18%) received a kidney transplant, followed by Hispanic (14%) and NHB (8%) children ( < 0.001). Etiologies of kidney failure with the highest proportion of children restarting dialysis were glomerulonephritis (51%) and congenital abnormalities (51%), while those with acute tubular necrosis (22%) were more likely to undergo transplant. Factors associated with the highest risk of restarting dialysis within 3 years of kidney recovery included longer time to initial recovery (>9 months HR 2.21, 95% CI 1.61-3.05 vs. < 3 months[ref]), cystic kidney disease (HR 2.12, 95% CI 1.61-3.05 vs. glomerulonephritis[ref]), age 5-12 years old at initial kidney failure (HR 1.77, 95% CI 1.17-2.68 vs. < 1 year old[ref]), and of Hispanic ethnicity (HR 1.44, 95% CI 1.03-2.00 vs. of NHW race[ref]).

Conclusion(s): 44% of children receiving outpatient dialysis in the U.S. restarted dialysis after achieving kidney recovery. Targeted interventions are needed to reduce the risk for restarting dialysis in those who were identified to have the highest risks for restarting dialysis.