Comparative analysis of hospitalizations among patients treated with hemodialysis and peritoneal dialysis in European pediatric nephrology centers: results from a prospective EPDWG/ESPN Dialysis Working Group study

Sevcan A Bakkaloğlu; Yeşim Özdemir Atikel; Claus Peter Schmitt; Eszter Lévai; Shazia Adalat; Nadine Goodman; İsmail Dursun; Ayşe Seda Pınarbaşı; Burcu Yazıcıoğlu; Fabio Paglialonga; Karel Vondrak; Isabella Guzzo; Nikoleta Printza; Aleksandra Zurowska; Ilona Zagożdżon; Aysun Karabay Bayazıt; Bahriye Atmış; Marcin Tkaczyk; Maria do Sameiro Faria; Ariane Zaloszyc; Augustina Jankauskienė; Mesiha Ekim; Alberto Edefonti; Rukshana Shroff

doi:10.1093/ckj/sfad291

Comparative analysis of hospitalizations among patients treated with hemodialysis and peritoneal dialysis in European pediatric nephrology centers: results from a prospective EPDWG/ESPN Dialysis Working Group study

Clin Kidney J. 2023 Dec 28;17(1):sfad291. doi: 10.1093/ckj/sfad291. eCollection 2024 Jan.

Authors

Sevcan A Bakkaloğlu¹, Yeşim Özdemir Atikel^{1

2}, Claus Peter Schmitt³, Eszter Lévai³, Shazia Adalat⁴, Nadine Goodman⁵, İsmail Dursun⁶, Ayşe Seda Pınarbaşı⁶, Burcu Yazıcıoğlu¹, Fabio Paglialonga⁷, Karel Vondrak⁸, Isabella Guzzo⁹, Nikoleta Printza¹⁰, Aleksandra Zurowska¹¹, Ilona Zagożdżon¹¹, Aysun Karabay Bayazıt¹², Bahriye Atmış¹², Marcin Tkaczyk¹³, Maria do Sameiro Faria¹⁴, Ariane Zaloszyc¹⁵, Augustina Jankauskienė¹⁶, Mesiha Ekim¹⁷, Alberto Edefonti⁷, Rukshana Shroff⁵

Affiliations

¹ Department of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey.
² Department of Pediatric Nephrology, Eskişehir City Hospital, Eskişehir, Turkey.
³ Department of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, Heidelberg, Germany.
⁴ Department of Pediatric Nephrology, Evelina London Children's Hospital, London, United Kingdom.
⁵ Department of Pediatric Nephrology, Great Ormond Street Hospital for Children, London, United Kingdom.
⁶ Department of Pediatric Nephrology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
⁷ Department of Pediatric Nephrology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁸ Department of Pediatric Nephrology, University Hospital Motol, Prague, Czech Republic.
⁹ UO di Nefrologia e Dialisi, Ospedale Pediatrico Bambino Gesu-IRCCS, Rome, Italy.
¹⁰ Department of Pediatric Nephrology, Medical School of Aristotle University, Thessaloniki, Greece.
¹¹ Department of Pediatrics Nephrology & Hypertension, Medical University of Gdansk, Gdansk, Poland.
¹² Department of Pediatric Nephrology, Çukurova University Faculty of Medicine, Adana, Turkey.
¹³ Department of Pediatric Nephrology, Instytut Centrum Zdrowia, Matki, Poland.
¹⁴ Department of Pediatric Nephrology, Centro Materno-Infantil do Norte, CHP, Porto, Portugal.
¹⁵ Department of Pediatric Nephrology, Country Hautepierre CHU, Strasbourg, France.
¹⁶ Institute of Clinical Medicine, Vilnius University, Pediatric Center, Vilnius, Lithuania.
¹⁷ Department of Pediatric Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey.

Abstract

Background and hypothesis: Hospital admissions in pediatric dialysis patients need to be better studied, and most existing studies are retrospective and based on registry data. This study aimed to analyse and compare hospital admission rates, causes, length of stay (LOS), and outcomes in children treated with peritoneal dialysis (PD) and hemodialysis (HD).

Methods: Data from 236 maintenance PD and 138 HD patients across 16 European dialysis centers were collected between 1 July 2017 and 30 June 2018. A total of 178 hospitalized patients (103 PD, 75 HD) were included for further analyses.

Results: There were 465 hospitalization events (268 PD, 197 HD) with a rate of 0.39 admissions per 100 patient-days at risk (PDAR) and 2.4 hospital days per 100 PDAR. The admission rates were not significantly different between HD and PD patients. The most common causes of hospitalization were access-related infections (ARI) (17%), non-infectious complications of access (NIAC) (14%), and infections unrelated to access (12%). ARI was the leading cause in PD patients (24%), while NIAC was more common in HD patients (19%). PD patients had more ARIs, diagnostic procedures, and treatment adjustments (P < .05), while HD patients had more NIACs, infections unrelated to access, access placement procedures, and interventional/surgical procedures (P < .001). LOS was longer with acute admissions than non-acute admissions (P < .001). Overall LOS and LOS in the intensive care unit were similar between HD and PD patients. High serum uric acid and low albumin levels were significant predictors of longer LOS (P = .022 and P = .045, respectively). Young age, more significant height deficit, and older age at the start of dialysis were predictors of longer cumulative hospital days (P = .002, P = .001, and P = .031, respectively).

Conclusion: Access-related complications are the main drivers of hospitalization in pediatric dialysis patients, and growth and nutrition parameters are significant predictors of more extended hospital stays.

Keywords: children; hemodialysis; hospitalization; length of stay; peritoneal dialysis.