Mortality trends in pediatric patients with chronic renal failure

Mortality trends were analyzed in 441 children and adolescents with chronic renal failure (CRF) observed over a 24-year period before and after institution of renal replacement therapy (RRT). A total of 93 patients died. Overall mortality rate (MR) per 100 patient years decreased from 6.6 in 1969–1978 to 2.5 in 1979–1988 and increased slightly to 2.9 in 1989–1992. The fall involved all four modes of treatment: conservative hemodialysis (HD), continuous peritoneal dialysis (CPD), and transplantation (TX). From 1979–1988 to 1989–1992 MR on conservative and on dialysis treatment changed only slightly and was similar on HD and CPD. An alarming rise in MR was noted after TX in 1989–1992, mainly due to malignant tumors. In 44 patients who died on conservative treatment, the reasons for non-acceptance for RRT were analyzed: in 22 multi-morbidity was the main reason, usually because of a congenital neurological disorder. Some patients died from advanced uremia or unexpected events after the decision to institute RRT. Our experience demonstrates a persistent mortality in pediatric patients with CRF, which in recent years is primarily ascribed to congenital multi-morbid conditions which make RRT unfeasible, infections on dialysis treatment, and malignancies after TX.