Barriers to pre-emptive kidney transplantation in New Zealand children.
child
kidney
paediatric
pre-emptive
renal
transplant
Journal
Journal of paediatrics and child health
ISSN: 1440-1754
Titre abrégé: J Paediatr Child Health
Pays: Australia
ID NLM: 9005421
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
revised:
05
03
2021
received:
11
12
2020
accepted:
22
04
2021
pubmed:
8
5
2021
medline:
25
2
2023
entrez:
7
5
2021
Statut:
ppublish
Résumé
Pre-emptive kidney transplantation (PKT) is generally considered the optimal treatment for kidney failure as it minimises dialysis-associated morbidity and mortality and is associated with improved allograft survival. This study aimed to determine rates of paediatric PKT in New Zealand, identify barriers to PKT and consider potential interventions to influence future rates of pre-emptive transplantation. Children commencing kidney replacement therapy between 2005 and 2017 in New Zealand were included. Descriptive analysis considered those referred late (referral <3 months prior to kidney replacement therapy initiation) or early based on referral timing to paediatric nephrology. Additional analysis compared characteristics of children receiving dialysis versus pre-emptive transplant as their first mode of kidney replacement therapy. PKT occurred in 15 of 90 children (17%). One-third of all patients were referred late. No late referrals received a pre-emptive transplant. Pre-emptively transplanted children were referred younger (median age 0.49 years), lived in less deprived areas, were more likely to have congenital anomalies of the kidney and urinary tract and none were Māori or Pasifika ethnicity. Late referral, higher deprivation levels and Māori and Pasifika ethnicity confer a greater risk of not receiving pre-emptive transplantation. Improved education amongst health professionals about recognition of paediatric chronic kidney disease and the importance of timely referral to paediatric nephrology is recommended to reduce rates of late referral. A modified approach including enhanced culturally appropriate support for those diagnosed with chronic kidney disease during transplant evaluation should be pursued to improve equity.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1490-1497Informations de copyright
© 2021 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).
Références
Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr. Nephrol. 2012; 27: 363-73.
McDonald SP, Craig JC. Long-term survival of children with end-stage renal disease. N. Engl. J. Med. 2004; 350: 2654-62.
Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int. 2016; 90: 1100-8.
Vats AN, Donaldson L, Fine RN, Chavers BM. Pretransplant dialysis status and outcome of renal transplantation in North American children: A NAPRTCS study. North American Pediatric Renal Transplant Cooperative Study. Transplantation 2000; 69: 1414-9.
ANZDATA Registry. 42nd Report, Chapter 12: Paediatric Patients with End Stage Kidney Disease Requiring Renal Replacement Therapy. Adelaide, Australia: Australia and New Zealand Dialysis and Transplant Registry; 2019.
Harambat J, van Stralen KJ, Schaefer F et al. Disparities in policies, practices and rates of pediatric kidney transplantation in Europe. Am. J. Transplant. 2013; 13: 2066-74.
Plumb L, Wong E, Casula A, et al. Chapter 4 Demography of the UKPaediatric renal replacement therapy population in 2016. Nephron 2018;139 Suppl. 1:105-16.
Smith JM, Martz K, Blydt-Hansen TD. Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: A report of the North American pediatric renal trials and collaborative studies. Pediatr. Transplant. 2013; 17: 149-57.
Grace BS, Kara T, Kennedy SE, McDonald SP. Racial disparities in pediatric kidney transplantation in New Zealand. Pediatr. Transplant. 2014; 18: 689-97.
Boehm M, Winkelmayer WC, Arbeiter K, Mueller T, Aufricht C. Late referral to paediatric renal failure service impairs access to pre-emptive kidney transplantation in children. Arch. Dis. Child. 2010; 95: 634-8.
Kim JS, Marlais M, Balasubramanian R et al. UKnational study of barriers to renal transplantation in children. Arch. Dis. Child. 2021; 106: 384-6.
Baer G, Lameire N, Van Biesen W. Late referral of patients with end-stage renal disease: An in-depth review and suggestions for further actions. NDT Plus 2010; 3: 17-27.
Schwartz GJ, Muñoz A, Schneider MF et al. New equations to estimate GFR in children with CKD. J. Am. Soc. Nephrol. 2009; 20: 629-37.
Crampton JACSP. NZDep2013 Index of Deprivation. Wellington, New Zealand: University of Otago; 2014.
Pruthi R, Casula A, Inward C, Roderick P, Sinha MD. Early requirement for RRT in children at presentation in the United Kingdom: Association with transplantation and survival. Clin. J. Am. Soc. Nephrol. 2016; 11: 795-802.
Jander A, Nowicki M, Tkaczyk M et al. Does a late referral to a nephrologist constitute a problem in children starting renal replacement therapy in Poland? A nationwide study. Nephrol. Dial. Transplant. 2006; 21: 957-61.
van Stralen KJ, Tizard EJ, Jager KJ et al. Determinants of eGFR at start of renal replacement therapy in paediatric patients. Nephrol. Dial. Transplant. 2010; 25: 3325-32.
Wavamunno MD, Harris DC. The need for early nephrology referral. Kidney Int. Suppl. 2005; 94: S128-32.
Hogg RJ, Furth S, Lemley KV, et al. National Kidney Foundation's Kidney Disease Outcomes Quality Initiative clinical practice guidelines for chronic kidney disease in children and adolescents: Evaluation, classification, and stratification. Pediatrics 2003;111(6 Pt 1):1416-21.
Wauters JP, Lameire N, Davison A, Ritz E. Why patients with progressing kidney disease are referred late to the nephrologist: On causes and proposals for improvement. Nephrol. Dial. Transplant. 2005; 20: 490-6.
bpacnz. The detection and management of patients with chronic kidney disease in primary care. Best Pract. J. 2015; 66: 36-45.
National Renal Advisory Board. Aotearoa New Zealand Nephrology 13th Annual Report. 2018. Accessed 2 March 2021. Available from: https://www.health.govt.nz/system/files/documents/pages/2020_nrab_nephrology_activity_report_2018_data.pdf.
Atkinson MA, Roem JL, Gajjar A, Warady BA, Furth SL, Muñoz A. Mode of initial renal replacement therapy and transplant outcomes in the chronic kidney disease in children (CKiD) study. Pediatr. Nephrol. 2020; 35: 1015-21.
Patzer RE, Sayed BA, Kutner N, McClellan WM, Amaral S. Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am. J. Transplant. 2013; 13: 1769-81.
Martin P. Finding a living kidney donor: Experiences of New Zealand renal patients. Aust. Health Rev. 2013; 37: 1-53.
The Transplantation Society of Australia and New Zealand. Clinical Guidelines for Organ Transplantation from Deceased Donors. 2020.