End-stage renal disease in Kuwaiti children: an 8-year experience

BACKGROUND: Prior to the establishment of the pediatric nephrology service in Kuwait in 1995, no accurate registry of end-stage renal disease in children was available due to management by various adult nephrologists. In this study we analyzed our experience with renal replacement therapy in children, as the only center in the country offering this service for the past 8 years. SUBJECTS AND METHODS: The records included all children less than 16 years of age with end-stage renal disease treated in the pediatric nephrology unit over a period of 8 years (January 1995 to December 2002). RESULTS: Of the 48 children boys comprises 52% and the overall mean age at institution of dialysis was 94.4 months. Causes of renal disease included congenital structural anomalies in 52%, including obstructive uropathy in 16.6%, vesicoureteric reflux in 16.6%, and renal dysplasia/hypoplasia in 18.7%. Hereditary nephropathy was diagnosed in 35.4%, including primary hyperoxaluria in 10.4%, nephronophthisis in 2%, autosomal-recessive polycystic renal disease in 8%, and glomerulopathies in 14.5%. Other etiologies constituted 14%. Renal replacement therapy was necessary in 43 patients: 46% by peritoneal dialysis and 43% by hemodialysis. The mortality rate in the dialyzed group was 16%. Twenty-four patients received kidney transplants from, cadaveric donors in 19 cases. CONCLUSION: Genetic factors contributed to the high incidence of end-stage renal disease, which is most likely due to the common practice of consanguineous marriages in our country.