There was a significant decrease in the United States in mortality rates over time among children and adolescents initiating end-stage renal disease treatment with dialysis between 1990 and 2010, according to a study of more than 20,000 patients published in the May 8 issue of the Journal of the American Medical Association..

Mark M. Mitsnefes, MD, M.Sc., of Cincinnati Children's Hospital Medical Center, and colleagues conducted a study to determine if all-cause, cardiovascular, and infection-related mortality rates have changed between 1990 and 2010 among patients younger than 21 years of age with ESRD initially treated with dialysis and if changes in mortality rates over time differed by age at treatment initiation. The researchers used data from the United States Renal Data System. Children with a prior kidney transplant were excluded.

“In no group of [ESRD] patients is the loss of potential years of life larger than in children and adolescents,” the author's wrote.“Almost all children initiating [ESRD] treatment are considered eligible for transplant. However, most will require dialysis during their lifetime, either before transplant or after allograft loss.”

The researchers identified 23,401 children and adolescents who met study criteria. Crude mortality rates during dialysis treatment were higher among children younger than five years at the start of dialysis compared with those who were five years and older. The authors found that the all-cause mortality risk decreased progressively over calendar time for both those younger than five years and those five years and older at initiation. There was also a decrease over calendar time for cardiovascular and infection-related mortality risk among children younger than five years at initiation and among those five years and older.

“Numerous factors may have contributed to the observed reductions in mortality risk over time. Improved pre-dialysis care, advances in dialysis technology, and greater experience of clinicians may each have played a role,” the authors wrote.