INCIDENCE AND PREDICTORS OF VASCULAR EVENTS FOLLOWING END STAGE KIDNEY DISEASE IN CHILDHOOD

AK LE PAGE^1,2, SE KENNEDY^2,3,4, A DURKAN^2,5, S CHATURVEDI^2,6,7, A WALKER^2,8, MP SYPEK^1,8,9

¹Dept of Nephrology, Monash Children’s Hospital, Clayton, , ²Australian and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia., Adelaide, , ³Department of Nephrology, Sydney Children’s Hospital, Randwick , , ⁴School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Randwick , , ⁵Department of Nephrology, Children’s Hospital at Westmead, , , ⁶Department of Paediatrics, Royal Darwin Hospital, , , ⁷Menzies School of Health Research, Charles Darwin University, Darwin, , ⁸Department of Nephrology, Royal Children’s Hospital, Parkville, , ⁹University of Melbourne, Parkville

Aim: We aimed to describe the incidence of new onset vascular disease and vascular death in Australian children receiving renal replacement therapy (RRT).  We also aimed to evaluate whether demographic or childhood clinical factors predict these endpoints, and whether vascular disease predicts mortality.
Background: Cardiovascular death is a leading cause of mortality in paediatric end stage kidney disease (ESKD). There is however relatively little known about clinically relevant vascular disease in this population.
Methods: Data on Australian patients who commenced RRT at <18 years of age from 1991-2017 were extracted from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). The association of variables with outcomes were evaluated using Fine and Gray competing risk models.
Results: A cohort of 1268 patients were followed up for a median of 10.31 years. Vascular disease was reported in 5.4%, and vascular death in 4.1%. The cumulative incidence of any vascular event, i.e. disease or death, at 10 and 20 years was 5.5% and 12.8% respectively. Vascular events were predicted by non-Caucasian (especially Indigenous) ethnicity.  For the 804 patients who were followed-up after 18 years of age, vascular disease was predicted by longer childhood dialysis duration and vascular mortality by lack of transplantation during childhood. Whilst vascular disease was only reported for 15.4% of patients who had a vascular death, it was predictive of mortality.
Conclusion: Cumulative incidence of vascular events is significant after commencing RRT during childhood. Vascular events are associated with ethnicity, longer childhood dialysis duration and lack of transplantation during childhood.

Biography:
Paediatric Nephrologist at Monash Children’s Hospital.
Chair ANZDATA paediatric working group.