00 intro pages

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

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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

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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

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100

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300

400

500

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Male

Female

Diabetes Glomerulo-nephritis (GN)

Secondary GN/vasculitis

Interstitialnephritis

Hypertension Cystic/hereditary/congenital

Neoplasm/cancer

White Black Native American Asian

Perc

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40

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Glomerulonephritis


Interstitial nephritis/pyelonephritis

Hypertension

Cystic/hereditary/congenital

Neoplasms/tumors

Ag

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Mean age

Median age




Hypertension Neoplasm/cancer


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

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Num

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80

120

160

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240

280

Male

Female






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


Perc

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25

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35

40 Diabetes

Glomerulonephritis



Hypertension


Neoplasms/tumors

Ag

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5

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20Mean age

Median age






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Perc

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White

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Hypertension Cystic/hereditary/congenital

Neoplasm/cancer

Perc

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10

20

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40

50

60

70

80

90

100White

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Native American

Asian






DM GN SGN Inst. HTN Cyst. Neopl.

Perc

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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

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Perc

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30

40

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60 Diabetes

Glomerulonephritis



Hypertension


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


Perc

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odal

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10

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100Hemodialysis

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Transplant

Death

Unknown

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Hemodialysis

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Transplant

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Other

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1994 1995 1996 1997 1998

Num

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of t

rans

pla

nts

100

150

200

250

Cadaver (247, -31%)Living (154, 30%)

Male Female Male FemaleMale Female

Tran

spla

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per

100

pat

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yea

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ialy

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0

5

10

15

20

25

30Cadaver

Living donor

Male Female


Male Female Male FemaleMale Female

Tran

spla

nts

per

100

pat

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yea

rs o

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ialy

sis

0

5

10

15

20

25

30Cadaver

Living donor

Male Female


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

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Months of survival

0 12 24 36 48 60

Perc

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urvi

ving

0

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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


White

Perc

ent s

urvi

vin

g

70

80

90

100


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

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White

Perc

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urvi

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g20

40

60

80

100


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


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


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


1994 1995 1996 1997 1998

Num

ber

of t

rans

pla

nts

0

20

40

60

Cadaver (53, -28%)Living (11, -55%)

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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

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Cardiovascular overall Infection overall Infection, vascular access Vascular access overall

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Cardiovascular overall Infection overall Infection, peritonitis Catheter complication

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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

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2 -<5 years

5+ years

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By age group By gender

Figure 6.32Admissions for infection (overall)by time on ESRDdialysis patients, 1996–1998combined

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Figure 6.33Admissions for infection (overall)by time on ESRDhemodialysis patients, 1996–1998 combined

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Figure 6.34Admissions for infection (overall)by time on ESRDperitoneal dialysis patients,1996–1998 combined

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Figure 6.36Admissions for respiratoryinfections by time on ESRDdialysis patients, 1996–1998combined

Figure 6.37Admissions for respiratoryinfections by time on ESRDtransplant patients, 1996–1998combined

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Figure 6.35Admissions for infection (overall)by time on ESRDtransplant patients, 1996–1998combined

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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

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Figure 6.41Causes of death by raceprevalent hemodialysis patients,1996–1998 combined


Figure 6.43Causes of death by raceprevalent transplant patients,1996–1998 combined


Figure 6.42Causes of death by raceprevalent peritoneal dialysispatients, 1996–1998 combined


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00 intro pages

Health & Medicine

incident rates

lower rates

higher rates

equivalent rates

admission rates

white children

asian patients

pediatric patients