Timing of renal replacement therapy initiation and choosing the optimal modality for pediatric patients with hypo/dysplastic kidney

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There are currently no evidence‐based initiation strategies for performing renal replacement therapy (RRT) for pediatric patients with end‐stage renal disease. We retrospectively examined the timing of RRT initiation and choice of the modality in patients with hypo/dysplastic kidney, which is the major cause of end‐stage renal disease in children. Fourteen patients were included in this study. At the time of the initiation of RRT, the mean age was 11.5±5.8 years, and the mean estimated GFR (eGFR) was 10.1±3.1ml/min/1.73m2. The mean time from the diagnosis of hypo/dysplastic kidney to the initiation of RRT was 6.7±3.7 years. In all patients, the urine volume and serum levels of potassium, phosphate, and bicarbonate were well maintained within the normal limits at the time of the initiation of RRT. Of the 14 patients, dialysis was initiated in 7 patients and preemptive kidney transplantation (PEKT) was performed in the remaining 7 patients. The mean eGFR at the time of RRT initiation was significantly higher in the PEKT group than in the dialysis group (eGFR 12.0±2.9 and 8.6±2.3ml/min/1.73m2, respectively). Four patients in the dialysis group started dialysis following unexpected clinical events, although these events were not seen in any of the PEKT group patients. Since patients with hypo/dysplastic kidney showed a constant slope of progression, PEKT was considered to be a reliable therapeutic option for these patients. In addition, our results suggested that it is safe to start dialysis when the eGFR is around 10m/min/1.73m2, even if asymptomatic, in pediatric patients with hypo/dysplastic kidney.

Timing of renal replacement therapy initiation and choosing the optimal modality for pediatric patients with hypo/dysplastic kidney

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