Children on dialysis for severe kidney disease have a dramatically reduced risk of death compared to 20 years ago, a new study shows. The findings, from a study led by Dr. Bethany Foster from the Research Institute of the McGill University Health Centre (RI-MUHC) and McGill University, are very encouraging for children with end-stage kidney disease.

These children face a significantly shortened life expectancy, with dialysis as the only life-saving therapy while they await transplant. This study was published in The Journal of the American Medical Association (JAMA).

"This is important for children who need to spend longer periods of time on dialysis because they cannot receive a transplant or their transplantation failed," says Dr. Bethany Foster, corresponding author of the study and pediatric nephrologist at the Montreal Children's Hospital in Montreal. "Infants are one group that have to spend a longer time on dialysis because they have to grow - usually to between one and two years of age before they can get a transplant."

Also known as end-stage renal disease (ESRD), this condition occurs when the kidneys are no longer able to perform at a level needed for day-to-day life. At that point, dialysis becomes a life-saving therapy while they await transplant. Unfortunately, children on dialysis with ESRD face a significant risk of death, up to 30 times higher than for healthy children, according to Dr. Foster.

"We wanted to see how outcomes have changed over time in children with ESRD who were treated with dialysis," explains Dr. Foster who is also an Associate Professor of Pediatrics at McGill University. Researchers analyzed an American database of more than 20,000 children who had received dialysis between 1990 and 2010. They found that the risk of death for children or adolescents being treated with dialysis has decreased dramatically, by about 20 per cent, over each five year period.

"Numerous factors may have contributed to the reduction in mortality risk over time such as improved pre-dialysis care, advances in dialysis technology, and greater experience of clinicians," says Dr. Foster. "Additional good news is that the period of time children spend on dialysis before transplant has also become shorter in recent years following changes in the way donated kidneys are allocated to children on the waiting list. Waiting times for children are substantially shorter than they used to be." A lower risk of death while being treated with dialysis, combined with a shorter time on dialysis adds up to a much brighter outlook for these children.

Further research is needed to determine the specific factors responsible for this decrease, but according to Dr. Foster and her colleagues, the results of this study are not only important for children who need dialysis, but also for their families, to help them understand that while dialysis is not a risk free undertaking, those risks have been dramatically decreased over time. As a result, these children are much more likely to be in good health when they arrive at the transplant phase.

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