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Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatric dialysis registry

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Abstract

Background

Sociocultural issues play a key role in children needing kidney replacement therapy (KRT).

Methods

Data of incident patients < 18 years treated with chronic dialysis or preemptive kidney transplantation (pTx) between 2007 and 2016 were retrospectively collected from the Italian Pediatric Dialysis Registry; KRT modality and outcome were compared between patients with at least one non-Italian parent (“resident foreign patients,” RFPs) and those from native parents (“domestic patients,” DPs) and between the quinquennium 2007–2011 (period 1) and 2012–2016 (period 2).

Results

We included 448 children (26.8% RFPs). The percentage of RFPs increased from 23 to 30.3% (p = 0.08) from periods 1 to 2. They were younger (6.7 vs. 9.4 years, p = 0.025) and less often treated with pTx (3.3 vs. 13.4%, p = 0.009) than DPs. The percentage of pTx increased from period 1 to 2 in RFPs only (8.4–18.6%, p = 0.006). Independent predictors of a lower probability of pTx were lower age, belonging to RFPs group, starting KRT in period 1 and focal segmental glomerulosclerosis or glomerulopathy as primary kidney disease. Peritoneal dialysis was the preferred dialysis modality in both groups. Age, primary kidney disease, and center size were independently associated with dialysis modality choice. Patient survival, waiting time to Tx, and dialysis modality survival were not different between the two groups.

Conclusions

The proportion of patients receiving KRT born from immigrant families increased in recent years in Italy. They were younger and less often treated with pTx than domestic patients. In case of dialysis, the outcome was not different between the two groups.

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References

  1. Grace BS, Kennedy SE, Clayton PA, McDonald SP (2014) Racial disparities in paediatric kidney transplantation. Pediatr Nephrol 29:125–132

    Article  Google Scholar 

  2. Omoloja A, Mitsnefes M, Talley L, Benfield M, Neu A (2007) Racial differences in graft survival: a report from the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Clin J Am Soc Nephrol 2:524–528

    Article  Google Scholar 

  3. Tjaden LA, Noordzij M, van Stralen KJ, Kuehni CE, Raes A, EAM C, O’Brien C, Papachristou F, Schaefer F, Groothoff JW, Jager KJ, ESPN/ERA-EDTA Registry Study Group (2016) Racial disparities in access to and outcomes of kidney transplantation in children, adolescents, and young adults: results from the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association/European Dialysis and Transplant Association) Registry. Am J Kidney Dis 67:293–301

    Article  Google Scholar 

  4. Harambat J, van Stralen KJ, Verrina E, Groothoff JW, Schaefer F, Jager KJ, ESPN/ERA-EDTA Registry (2014) Likelihood of children with end-stage kidney disease in Europe to live with a functioning kidney transplant is mainly explained by nonmedical factors. Pediatr Nephrol 29:453–459

    Article  Google Scholar 

  5. Patzer RE, Sayed BA, Kutner N, McClellan WM, Amaral S (2013) Racial and ethnic differences in pediatric access to preemptive kidney transplantation in the United States. Am J Transplant 13:1769–1781

    Article  CAS  Google Scholar 

  6. Oztek FZ, Ipsiroglu O, Mueller T, Aufricht C (2009) Outcome after renal transplantation in children from native and immigrant families in Austria. Eur J Pediatr 168:11–16

    Article  Google Scholar 

  7. McEnhill ME, Brennan JL, Winnicki E, Lee MM, Tavakol M, Posselt AM, Stock PG, Portale AA (2016) Effect of immigration status on outcomes in pediatric kidney transplant recipients. Am J Transplant 16:1827–1833

    Article  CAS  Google Scholar 

  8. Furth SL, Garg PP, Neu AM, Hwang W, Fivush BA, Powe NR (2000) Racial differences in access to the kidney transplant waiting list for children and adolescents with end-stage renal disease. Pediatrics 106:756–761

    Article  CAS  Google Scholar 

  9. Furth SL, Powe NR, Hwang W, Neu AM, Fivush BA (1997) Racial differences in choice of dialysis modality for children with end-stage renal disease. Pediatrics 99:E6

    Article  CAS  Google Scholar 

  10. Schoenmaker NJ, Tromp WF, van der Lee JH, Adams B, Bouts AH, Collard L, Cransberg K, van Damme-Lombaerts R, Godefroid N, van Hoeck KJ, Koster-Kamphuis L, Lilien MR, Raes A, Groothoff JW (2012) Disparities in dialysis treatment and outcomes for Dutch and Belgian children with immigrant parents. Pediatr Nephrol 27:1369–1379

    Article  Google Scholar 

  11. Tromp WF, Cransberg K, van der Lee JH, Bouts AH, Collard L, Van Damme-Lombaerts R, Godefroid N, Van Hoeck KJ, Koster-Kamphuis L, Lilien MR, Raes A, Ranguelov N, Groothoff JW (2012) Fewer preemptive renal transplantations and more rejections in immigrant children compared to native Dutch and Belgian children. Nephrol Dial Transplant 27:2588–2593

    Article  Google Scholar 

  12. Laster M, Soohoo M, Hall C, Streja E, Rhee CM, Ravel VA, Reddy U, Norris KC, Salusky IB, Kalantar-Zadeh K (2017) Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients. Pediatr Nephrol 32:685–695

    Article  Google Scholar 

  13. Schoenmaker NJ, Haverman L, Tromp WF, van der Lee JH, Offringa M, Adams B, Bouts AH, Collard L, Cransberg K, van Dyck M, Godefroid N, van Hoeck K, Koster-Kamphuis L, Lilien MR, Raes A, Taylan C, Grootenhuis MA, Groothoff JW (2014) Children of non-Western origin with end-stage renal disease in the Netherlands, Belgium and a part of Germany have impaired health-related quality of life compared with Western children. Nephrol Dial Transplant 29:448–457

    Article  Google Scholar 

  14. Verrina E, Edefonti A, Gianoglio B, Rinaldi S, Sorino P, Zacchello G, Lavoratti G, Maringhini S, Pecoraro C, Calevo MG, Turrini Dertenois L, Perfumo F (2004) A multicenter experience on patient and technique survival in children on chronic dialysis. Pediatr Nephrol 19:82–90

    Article  Google Scholar 

  15. World Bank database. http://data.worldbank.it/. Accessed Mar 2020

  16. Istituto Nazionale di Statistica. http://istat.it/. Accessed Mar 2020

  17. Patzer RE, Amaral S, Klein M, Kutner N, Perryman JP, Gazmararian JA, McClellan WM (2012) Racial disparities in pediatric access to kidney transplantation: does socioeconomic status play a role? Am J Transplant 12:369–378

    Article  CAS  Google Scholar 

  18. Amaral S, Patzer RE, Kutner N, McClellan W (2012) Racial disparities in access to pediatric kidney transplantation since share 35. J Am Soc Nephrol 23:1069–1077

    Article  Google Scholar 

  19. Amaral S, Patzer R (2013) Disparities, race/ethnicity and access to pediatric kidney transplantation. Curr Opin Nephrol Hypertens 22:336–343

    Article  CAS  Google Scholar 

  20. Boehm M, Winkelmayer WC, Arbeiter K, Mueller T, Aufricht C (2010) Late referral to paediatric renal failure service impairs access to preemptive kidney transplantation in children. Arch Dis Child 95:634–638

    Article  CAS  Google Scholar 

  21. Bratton C, Chavin K, Baliga P (2011) Racial disparities in organ donation and why. Curr Opin Organ Transplant 16:243–249

    Article  Google Scholar 

  22. Ismail SY, Luchtenburg AE, Kal-V Gestel JA, Zuidema WC, Weimar W, Busschbach JJ, Massey EK (2013) Modifiable factors in access to living-donor kidney transplantation among diverse populations. Transplantation 96:586–590

    Article  Google Scholar 

  23. Liem YS, Weimar W (2009) Early living-donor kidney transplantation: a review of the associated survival benefit. Transplantation 87:317–318

    Article  Google Scholar 

  24. Butani L, Perez RV (2011) Effect of pretransplant dialysis modality and duration on long-term outcomes of children receiving renal transplants. Transplantation 91:447–451

    Article  Google Scholar 

  25. Sinha R, Marks SD (2010) Comparison of parameters of chronic kidney disease following paediatric preemptive versus nonpreemptive renal transplantation. Pediatr Transplant 14:583–588

    Article  Google Scholar 

  26. Gillen DL, Stehman-Breen CO, Smith JM, McDonald RA, Warady BA, Brandt JR, Wong CS (2008) Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant 8:2600–2606

    Article  CAS  Google Scholar 

  27. Hogan J, Ranchin B, Fila M, Harambat J, Krid S, Vrillon I, Roussey G, Fischbach M, Couchoud C (2017) Effect of center practices on the choice of the first dialysis modality for children and young adults. Pediatr Nephrol 32:659–667

    Article  Google Scholar 

  28. Watson AR, Hayes WN, Vondrak K, Ariceta G, Schmitt CP, Ekim M, Fischbach M, Edefonti A, Shroff R, Holta T, Zurowska A, Klaus G, Bakkaloglu S, Stefanidis CJ, Van de Walle J (2013) Factors influencing choice of renal replacement therapy in European paediatric nephrology units. Pediatr Nephrol 28:2361–2368

    Article  Google Scholar 

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Authors and Affiliations

Authors

Contributions

FP, SC, EVid, AE, and EVer contributed to the study conception and design. Data collection were performed by all the authors. Data analysis was performed by FP, SC, and GP. The first draft of the manuscript was written by FP and initially revised by SC, EVid, AE, EVer. Each author contributed important intellectual content during manuscript drafting or revision. All the authors read and approved the final manuscript.

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Correspondence to Fabio Paglialonga.

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The authors declare that they have no conflicts of interest.

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Paglialonga, F., Consolo, S., Vidal, E. et al. Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatric dialysis registry. Pediatr Nephrol 36, 639–647 (2021). https://doi.org/10.1007/s00467-020-04730-0

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  • DOI: https://doi.org/10.1007/s00467-020-04730-0

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