00 intro pages
TRANSCRIPT
TSIX There is always one
moment in childhood
when the door opens
and lets the future in.
Graham Greene,
The Power and the Glory
PediatricESRD
All data underlying the
figures in this chapter,
as well as additional related
data, may be viewed &
downloaded at
www.usrds.org.
9 8 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Included in this chapter¨ Graphs and maps of incident and prevalent rates; graphs of pa-
tient distribution by modality, primary diagnosis, gender, race,and age; and graphs showing causes of renal failure by age groupand by race
¨ Graphs of first and repeat transplant rates, and Kaplan-Meiersurvival curves of patient and graft survival
¨ Graphs and maps of hospitalization rates by modality and byprimary diagnosis; graphs of heart disease by age and race
¨ Causes of death by race and modality
Included in this chapter
In pediatric ESRD patients of all age groups both
incident and prevalent rates have increased mod-
erately since 1990 (table 6.1). Rates continue to
be highest in the 15–19 age group, with particu-
larly high rates—three times those of whites—
seen in black children of both genders (fig 6.2).
Among pediatric dialysis patients the most com-
mon causes of renal failure are glomerulonephri-
tis and cystic/hereditary/congenital kidney dis-
ease, with the latter disease occurring almost twice
as often in male children as in females (fig 6.7).
Glomerulonephritis is more common in children
of color, and the rate of secondary glomerulone-
phritis/vasculitis is twice as high in Asian chil-
dren than in the other populations (fig 6.8). The
most frequent primary diagnosis among pediat-
ric transplant patients is cystic/hereditary/con-
genital kidney disease; the number of boys with
this diagnosis is almost three times as high as the
number of girls (fig 6.10).
While the numbers of living donor and cadav-
eric first transplants were similar between 1995
and 1997, the number of transplants from living
donors has begun to increase once again (a total
of 30% since 1994), while the number of cadav-
eric donations continues to decline (fig 6.19).
Transplant rates are highest in children aged 5–9,
and while cadaver transplants are slightly more
frequent in older children, children aged 0–4 are
almost twice as likely to receive a kidney from a
living donor (fig 6.20).
When examined in terms of race, transplants
from living donors are most common in white
and female Native American children, and least
likely to occur in black and Asian children (fig
6.21). The rates of cadaveric transplantation,
however, are highest in children of Asian descent.
Overall survival rates echo those of adult patients,
with rates dramatically lower for pediatric dialy-
sis patients than for children who have received
transplants (fig 6.22). Patient and graft survival
curves for both cadaver and living donor trans-
plants show generally equivalent rates in females
compared to males, but lower rates, in many age
groups, for black children compared to white (figs
6.23–26). Survival in black children also shows
the most variation by patient age.
Infection is more frequent in peritoneal dialysis
patients, and occurs with much higher rates in
the youngest children (figs 6.28–30). With the
exception of admissions for respiratory infections
in transplant patients, admission rates for over-
all and respiratory infections are higher in girls at
most stages of ESRD than in boys; the rate of res-
piratory infections in female dialysis patients, in
fact, increases steadily for these patients the longer
they have ESRD (figs 6.32–37).
Causes of death were generally similar between
genders, with the exception of cardiac arrest and
cardiac “other” causes in peritoneal dialysis pa-
tients; deaths attributed to these causes were at
least three times more common in girls (figs 6.38–
40). Twice as many white children on hemodi-
alysis died from infection; more black children
on peritoneal dialysis, in contrast, died from the
same cause, and cardiac arrest was more frequent
in this group as well (figs 6.41–42).
Future analyses will examine how regional dif-
ferences in socio-economic factors and in the
availability of pediatric nephrologists may be as-
sociated with outcomes in pediatric patients.
C H A P T E R 6 � P E D I A T R I C E S R D � 9 9
Table 6.1Incident & prevalent counts &ratesunadjusted
Includes only white, black, NativeAmerican, and Asian patients.
Figure 6.2Incident rates by race, gender, &age groupper million population, 1996–1998 combined, unadjusted
Figure 6.1Incident ratesper million population,unadjusted
1990 1991 1992 1993 1994 1995 1996 1997 19980
5
10
15
20
25
30
35 Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
White Black N. Am. Asian White Black N. Am. AsianWhite Black N. Am. Asian0
10
20
30
40
50
60
70
80Male
Female
White Black N. Am. Asian
Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
1990-1992 1993-1995 1996-1998Counts Incident Prevalent Incident Prevalent Incident Prevalent0- 4 391 941 479 1,163 552 1,1805- 9 338 1,838 419 2,053 409 2,24110-14 618 3,182 740 3,715 820 4,12415-19 1,332 6,329 1,548 7,212 168 7,803
Rates per million population0- 4 6.8 16.2 8.1 19.8 9.6 20.75- 9 6.2 33.6 7.4 36.2 6.9 37.710-14 11.7 59.3 13.2 66.0 14.3 72.015-19 25.5 121.8 29.0 133.6 28.2 134.5
1 0 0 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Figure 6.4Incident rates by raceper million population, 1994–1998 combined, by state, unadjusted
Figure 6.3Incident rates by age groupper million population, 1994–1998 combined, by state, unadjusted
Ages 0–4
Ages 5–9
Ages 10–14
Ages 15–19
White
Black
Native American
Asian
11.4 +9.4 to 11.47.9 to 9.46.0 to 7.9
below 6.0
8.6 +6.7 to 8.65.4 to 6.74.8 to 5.4below 4.8
14.9 +13.3 to 14.912.0 to 13.3
8.5 to 12.0below 8.5
32.3 +27.6 to 32.323.2 to 27.619.5 to 23.2below 19.5
11.9 +10.8 to 11.910.1 to 10.8
8.0 to 10.1below 8.0
33.5 +27.0 to 33.524.0 to 27.015.3 to 24.0below 15.3
11.6 +10.3 to 11.6
8.7 to 10.37.8 to 8.7
below 7.8
11.9 +5.7 to 11.95.1 to 5.73.3 to 5.1
below 3.3
C H A P T E R 6 � P E D I A T R I C E S R D � 1 0 1
Figures 6.5 & 6.6Incident rates by gender & primary diagnosisper million population, 1994–1998 combined, by state, unadjusted
Male
Diabetes
Other urologic
Female
Cystic kidney
Hypertension
Unknown cause
Glomerulonephritis
0.4 +0.3 to 0.40.2 to 0.30.1 to 0.2below 0.1
1.1 +0.7 to 1.10.4 to 0.70.1 to 0.4below 0.1
5.3 +4.5 to 5.34.0 to 4.53.2 to 4.0below 3.2
4.1 +3.3 to 4.12.9 to 3.32.4 to 2.9below 2.4
1.7 +1.1 to 1.71.0 to 1.10.8 to 1.0below 0.8
2.7 +2.3 to 2.71.9 to 2.31.6 to 1.9below 1.6
16.6 +14.6 to 16.613.4 to 14.612.0 to 13.4below 12.0
14.5 +12.7 to 14.511.2 to 12.7
7.9 to 11.2below 7.9
1 0 2 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Nu
mb
er o
f pat
ien
ts
0
100
200
300
400
500
600
700
800
Male
Female
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Cystic/hereditary/congenital
Neoplasm/cancer
White Black Native American Asian
Perc
ent o
f pat
ient
s w
ith d
iag
nosi
s
0
10
20
30
40
50
60Diabetes
Glomerulonephritis
Secondary GN/vasculitis
Interstitial nephritis/pyelonephritis
Hypertension
Cystic/hereditary/congenital
Neoplasms/tumors
Ag
e in
yea
rs
0
5
10
15
20
Mean age
Median age
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Neoplasm/cancer
Cystic/hereditary/congenital
Figure 6.7Number of patients, by gender,within primary diagnosis groupdialysis patients, 1994–1998combined
Figure 6.9Mean & median age withinprimary diagnosis groupdialysis patients, 1994–1998combined
Figure 6.8Distribution of primary diagnosiswithin racial groupdialysis patients, 1994–1998combined
C H A P T E R 6 � P E D I A T R I C E S R D � 1 0 3
Num
ber
of p
atie
nts
0
40
80
120
160
200
240
280
Male
Female
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Neoplasm/cancer
Cystic/hereditary/congenital
Figure 6.10Number of patients, by gender,within primary diagnosis grouptransplant patients, 1994–1998combined
Figure 6.12Mean & median age withinprimary diagnosis grouptransplant patients, 1994–1998combined
Figure 6.11Distribution of primary diagnosiswithin racial grouptransplant patients, 1994–1998combined
White Black Native American Asian
Perc
ent o
f pat
ien
ts w
ith d
iag
nosi
s
0
5
10
15
20
25
30
35
40 Diabetes
Glomerulonephritis
Secondary GN/vasculitis
Interstitial nephritis/pyelonephritis
Hypertension
Cystic/hereditary/congenital
Neoplasms/tumors
Ag
e in
yea
rs
0
5
10
15
20Mean age
Median age
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Neoplasm/cancer
Cystic/hereditary/congenital
1 0 4 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Perc
ent o
f pat
ient
s
0
10
20
30
40
50
60
70
80
90
100
White
Black
Native American
Asian
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Cystic/hereditary/congenital
Neoplasm/cancer
Perc
ent o
f pat
ient
s
0
10
20
30
40
50
60
70
80
90
100White
Black
Native American
Asian
Diabetes Glomerulo-nephritis (GN)
Secondary GN/vasculitis
Interstitialnephritis
Hypertension Neoplasm/cancer
Cystic/hereditary/congenital
DM GN SGN Inst. HTN Cyst. Neopl.
Perc
ent o
f pat
ient
s
0
10
20
30
40
50
60
70
80
90
100
Male
Female
DM GN SGN Inst. HTN Cyst. Neopl.
Dialysis Transplant
Figure 6.13Racial distribution withinprimary diagnosis groupdialysis patients, 1994–1998combined
Figure 6.15Gender distribution withinprimary diagnosis group1994–1998 combined
Diabetes, glomerulonephritis,secondary glomerulonephritis,interstitial nephritis/pyelone-phritis, hypertension, cystic kid-ney/hereditary/congenital, andneoplasms/tumors are abbrevi-ated along the x-axis.
Figure 6.14Racial distribution withinprimary diagnosis grouptransplant patients, 1994–1998combined
C H A P T E R 6 � P E D I A T R I C E S R D � 1 0 5
0-4 5-9 10-14 15-19
Perc
ent o
f pat
ient
s w
ith d
iag
nosi
s
0
10
20
30
40
50
60 Diabetes
Glomerulonephritis
Secondary GN/vasculitis
Interstitial nephritis/pyelonephritis
Hypertension
Cystic/hereditary/congenital
Neoplasms/tumors
Figure 6.16Causes of renal failure withinage groupincident patients, 1994–1998combined
Figure 6.18Treatment modality two yearsfollowing ESRD onset, within agegroupincident patients, 1994–1996combined
Figure 6.17Treatment modality two yearsfollowing ESRD onset, withinrace groupincident patients, 1994–1996combined
White Black Native American Asian
Perc
ent o
f pat
ient
s o
n m
odal
ity
0
10
20
30
40
50
60
70
80
90
100Hemodialysis
Peritoneal dialysis
Transplant
Death
Unknown
0-4 5-9 10-14 15-19
Perc
ent o
f pat
ient
s o
n m
odal
ity
0
10
20
30
40
50
60
70
80
90
100
Hemodialysis
Peritoneal dialysis
Transplant
Death
Other
1 0 6 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
1994 1995 1996 1997 1998
Num
ber
of t
rans
pla
nts
100
150
200
250
Cadaver (247, -31%)Living (154, 30%)
Male Female Male FemaleMale Female
Tran
spla
nts
per
100
pat
ient
yea
rs o
n d
ialy
sis
0
5
10
15
20
25
30Cadaver
Living donor
Male Female
Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
Male Female Male FemaleMale Female
Tran
spla
nts
per
100
pat
ient
yea
rs o
n d
ialy
sis
0
5
10
15
20
25
30Cadaver
Living donor
Male Female
White Black Native American Asian
Figure 6.19Total first transplants by donorsource & year
Includes patients not eligible forMedicare enrollment. The num-ber of transplants in 1994, andthe percent change between1994 and 1998, are indicated inthe legend.
Figure 6.21First transplant ratesby race & gender, 1996–1998combined
Figure 6.20First transplant ratesby age group & gender, 1996–1998 combined
C H A P T E R 6 � P E D I A T R I C E S R D � 1 0 7
Months of survival
0 12 24 36 48 60
Perc
ent s
urvi
ving
0
10
20
30
40
50
60
70
80
90
100
Ages 0-4Ages 5-9 Ages 10-14 Ages 15-19
0 12 24 36 48 60
Dialysis First transplant
Figure 6.22Kaplan-Meier 5-year patientsurvivalincident dialysis & transplantpatients, 1992–1993 combined
Figure 6.24Kaplan-Meier 5-year patientsurvival after first transplanta-tionliving donor transplants, 1992–1993 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
Figure 6.23Kaplan-Meier 5-year patientsurvival after first transplanta-tioncadaveric transplants,1992–1993combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
White
Perc
ent s
urvi
vin
g
70
80
90
100
Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
Black
Male
Months of survival
0 12 24 36 48 6070
80
90
100Female
0 12 24 36 48 60
White
Perc
ent s
urvi
ving
80
90
100
Ages 0-4Ages 5-9 Ages 10-14 Ages 15-19
Black
Male
0 12 24 36 48 6080
90
100Female
Months of survival
0 12 24 36 48 60
1 0 8 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
White
Perc
ent s
urvi
vin
g20
40
60
80
100
Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
Black
Male
Months of survival
0 12 24 36 48 6020
40
60
80
100Female
0 12 24 36 48 60
BlackWhite
Perc
ent s
urvi
ving 40
60
80
100
Ages 0-4 Ages 5-9 Ages 10-14 Ages 15-19
Male
0 12 24 36 48 60
40
60
80
100Female
Months of survival0 12 24 36 48 60
Figure 6.25Kaplan-Meier 5-year graftsurvival after first transplanta-tioncadaveric transplants, 1992–1993 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
Figure 6.27Total repeat transplants by donorsource & year
The number of repeat trans-plants in 1994, and the percentchange from 1994 to 1998, areshown in the legend. Includespatients not eligible for Medicareenrollment.
Figure 6.26Kaplan-Meier 5-year graftsurvival after first transplanta-tionliving donor transplants, 1992–1993 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
1994 1995 1996 1997 1998
Num
ber
of t
rans
pla
nts
0
20
40
60
Cadaver (53, -28%)Living (11, -55%)
C H A P T E R 6 � P E D I A T R I C E S R D � 1 0 9
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
0
10
20
30
40
50
60
70
80Ages 0-4
Ages 5-9
Ages 10-14
Ages 15-19
Cardiovascular overall Infection overall
Figure 6.28First hospital admission ratesall dialysis, 1996–1998 combined
Figure 6.30First hospital admission ratesperitoneal dialysis, 1996–1998combined
Figure 6.29First hospital admission rateshemodialysis, 1996–1998combined
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
0
10
20
30
40
50
60
70
80
90
100Ages 0-4
Ages 5-9
Ages 10-14
Ages 15-19
Cardiovascular overall Infection overall Infection, vascular access Vascular access overall
Ad
mis
sio
ns p
er 1
00 p
atie
nt y
ears
0
10
20
30
40
50
60
70
80
90
100Ages 0-4
Ages 5-9
Ages 10-14
Ages 15-19
Cardiovascular overall Infection overall Infection, peritonitis Catheter complication
1 1 0 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Figure 6.31Admission rates for hemodialysis & peritoneal dialysis patientsrates per 100 patient years at risk, by principal diagnosis or procedure category, 1996–1998 combined, by network
Alaska is included in Network 16, Hawaii in Network 17.
Network 11
Network 3
Network 1
Network 7
Network 2
Network 9
Network 6
Network 15
Network 8Network 13
Network 16
Network 17 and 18
Network 10
Network 4
Network 5Network 12
Network 14
Network 10
Network 7
Network 1
Network 3
Network 2
Network 5Network 9
Network 11
Network 4
Network 12
Network 8Network 13
Network17 and 18
Network 16
Network 15
Network 6
Network 14
Network 1
Network 7
Network 12Network 15
Network 2
Network 5Network 9
Network 6Network 8
Network 13
Network 16
Network17 and 18
Network 3
Network 10
Network 11
Network 14
Network 4
Network 1
Network 7
Network 5Network 9
Network 8Network 13
Network 16
Network17 and 18
Network 6
Network 2
Network 3
Network 11
Network 12
Network 14
Network 15
Network 4
Network 10
Network 7
Network 3
Network 2
Network 1
Network 5Network 9
Network17 and 18
Network 16
Network 6Network 13Network 8
Network 10
Network 11
Network 12
Network 14
Network 15
Network 4
Network 3
Network 2
Network 1
Network 7
Network 5
Network 4
Network 9Network
17 and 18
Network 6Network 8
Network 13
Network 16
Network 10
Network 11
Network 12
Network 14
Network 15
Network 7
Network 1
Network 5
Network 4
Network 9
Network 11
Network 14
Network 8
Network17 and 18
Network 16
Network 6Network 13
Network 2
Network 3
Network 12Network 15
Network 10Network 9
Network 3
Network 2
Network 7
Network 1
Network 5Network 12Network
17 and 18
Network 16
Network 6Network 8
Network 13
Network 10
Network 11
Network 14
Network 15
Network 4
Hemodialysis, cardiovascular overall
Hemodialysis, infection overall
Hemodialysis, vascular access overall
Hemodialysis, vascular access infection
Peritoneal dialysis, cardiovascular overall
Peritoneal dialysis, infection overall
Peritoneal dialysis, peritonitis
Peritoneal dialysis, catheter complication
19 +18 to 1911 to 18
7 to 11below 7
57 +48 to 5745 to 4837 to 45below 37
22 +19 to 2218 to 1914 to 18below 14
31 +24 to 3119 to 2413 to 19below 13
6 +5 to 64 to 52 to 4below 2
106 +86 to 10676 to 8667 to 76
below 67
34 +24 to 3422 to 2418 to 22below 18
26 +21 to 2618 to 2112 to 18below 12
C H A P T E R 6 � P E D I A T R I C E S R D � 1 1 1
0-4 5-9 10-14 15-19Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
at r
isk
0
20
40
60
80
100
120
140< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
Figure 6.32Admissions for infection (overall)by time on ESRDdialysis patients, 1996–1998combined
0-4 5-9 10-14 15-19
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
at r
isk
0
20
40
60
80
100
120
140< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
Figure 6.33Admissions for infection (overall)by time on ESRDhemodialysis patients, 1996–1998 combined
0-4 5-9 10-14 15-19
Ad
mis
sio
ns p
er 1
00 p
atie
nt y
ears
at r
isk
0
20
40
60
80
100
120
140< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
Figure 6.34Admissions for infection (overall)by time on ESRDperitoneal dialysis patients,1996–1998 combined
1 1 2 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
0-4 5-9 10-14 15-19
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
at r
isk
0
2
4
6
8
10< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
0-4 5-9 10-14 15-19
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
at r
isk
0
2
4
6
8
10
12
14
< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
Figure 6.36Admissions for respiratoryinfections by time on ESRDdialysis patients, 1996–1998combined
Figure 6.37Admissions for respiratoryinfections by time on ESRDtransplant patients, 1996–1998combined
0-4 5-9 10-14 15-19
Ad
mis
sion
s p
er 1
00 p
atie
nt y
ears
at r
isk
0
10
20
30
40
50
60< 1 year
1 -< 2 years
2 -<5 years
5+ years
Male Female
By age group By gender
Figure 6.35Admissions for infection (overall)by time on ESRDtransplant patients, 1996–1998combined
C H A P T E R 6 � P E D I A T R I C E S R D � 1 1 3
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
2
4
6
8
10
12Male
Female
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown
Figure 6.38Causes of death by genderprevalent hemodialysis patients,1996–1998 combined
Figure 6.40Causes of death by genderprevalent transplant patients,1996–1998 combined
Figure 6.39Causes of death by genderprevalent peritoneal dialysispatients, 1996–1998 combined
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
2
4
6
8
10
12
Male
Female
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
2
4
6
8
10
12Male
Female
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown
1 1 4 � 2 0 0 0 A T L A S O F E S R D I N T H E U N I T E D S T A T E S
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
3
6
9
12
15
White
Black
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown
Figure 6.41Causes of death by raceprevalent hemodialysis patients,1996–1998 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
Figure 6.43Causes of death by raceprevalent transplant patients,1996–1998 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
Figure 6.42Causes of death by raceprevalent peritoneal dialysispatients, 1996–1998 combined
Because of the small number ofpatients, data are not shown forNative American or Asian pa-tients.
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
3
6
9
12
15
White
Black
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown
Dea
ths
per
1,0
00 p
atie
nt y
ears
at r
isk
0
3
6
9
12
15
White
Black
Cerebrovasculardisease
Cardiac arrest Cardiac other Infection Malignancy Other known Unknown