Modality, utilization and mortality in pediatric ESKD: a registry-based study
- 1Department of Medicine, Division of Nephrology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
- 2Division of Pediatric Nephrology, SUNY Downstate Health Sciences University, Brooklyn, NY, United States
- 3Department of Medicine, Division of Nephrology, NYC Health + Hospitals/Kings County, Brooklyn, NY, United States
Abstract
IntroductionPediatric end-stage renal disease (ESKD) is rare but clinically complex. This study evaluated modality utilization, transplant access, and mortality among pediatric ESKD patients in the IPRO Network registry.MethodsWe performed a retrospective registry-based analysis of 1,628 pediatric ESKD patients from four U.S. regions between 2018 and 2024. Descriptive statistics summarized patient characteristics and treatment patterns. Competing risk models were used to assess time to modality transition, transplant listing, transplantation, and survival.ResultsPediatric patients represented 0.65% of all ESKD cases in the network. Peritoneal dialysis (PD) was the most common initial modality in children aged 0–2 years (72%), compared with 24% in those aged 15–17 years. Overall, 46% started hemodialysis (HD), 31% PD, and 23% were preemptively listed for transplantation. Transitions from HD to PD were uncommon. Transplant listing occurred in 63% of patients by 1 year and 81% by 3 years; transplantation occurred in 22% and 53%, respectively. One-, two-, and three-year mortality rates were 3.4%, 5.4%, and 6.6%, with the highest mortality rate in children aged 0–2 years (10% at 3 years).DiscussionPD is the preferred initial modality in very young children, while older children more often start hemodialysis. Overall survival and transplant access were favorable, but infants and toddlers remained the most vulnerable subgroup.ConclusionPediatric ESKD accounts for a small but distinct share of the ESKD population. Early transplant access and good short-term survival were observed, but outcomes remain poorest in the youngest children.
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BibTeX
@article{saggi2026modality,
title = {{Modality, utilization and mortality in pediatric ESKD: a registry-based study}},
author = {Subodh J. Saggi and Anil Mongia and Angelika C. Gruessner and Mary Mallappallil and Mary Mallappallil and Moro Salifu},
journal = {Frontiers in Nephrology},
year = {2026},
month = oct,
doi = {10.3389/fneph.2026.1930091},
url = {https://doi.org/10.3389/fneph.2026.1930091},
note = {CC BY},
}
RIS
TY - JOUR
TI - Modality, utilization and mortality in pediatric ESKD: a registry-based study
AU - Subodh J. Saggi
AU - Anil Mongia
AU - Angelika C. Gruessner
AU - Mary Mallappallil
AU - Mary Mallappallil
AU - Moro Salifu
PY - 2026
DA - 2026/10/26
JO - Frontiers in Nephrology
DO - 10.3389/fneph.2026.1930091
UR - https://doi.org/10.3389/fneph.2026.1930091
AB - IntroductionPediatric end-stage renal disease (ESKD) is rare but clinically complex. This study evaluated modality utilization, transplant access, and mortality among pediatric ESKD patients in the IPRO Network registry.MethodsWe performed a retrospective registry-based analysis of 1,628 pediatric ESKD patients from four U.S. regions between 2018 and 2024. Descriptive statistics summarized patient characteristics and treatment patterns. Competing risk models were used to assess time to modality transition, transplant listing, transplantation, and survival.ResultsPediatric patients represented 0.65% of all ESKD cases in the network. Peritoneal dialysis (PD) was the most common initial modality in children aged 0–2 years (72%), compared with 24% in those aged 15–17 years. Overall, 46% started hemodialysis (HD), 31% PD, and 23% were preemptively listed for transplantation. Transitions from HD to PD were uncommon. Transplant listing occurred in 63% of patients by 1 year and 81% by 3 years; transplantation occurred in 22% and 53%, respectively. One-, two-, and three-year mortality rates were 3.4%, 5.4%, and 6.6%, with the highest mortality rate in children aged 0–2 years (10% at 3 years).DiscussionPD is the preferred initial modality in very young children, while older children more often start hemodialysis. Overall survival and transplant access were favorable, but infants and toddlers remained the most vulnerable subgroup.ConclusionPediatric ESKD accounts for a small but distinct share of the ESKD population. Early transplant access and good short-term survival were observed, but outcomes remain poorest in the youngest children.
SN - 2813-0626
ER -