Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatr
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ORIGINAL ARTICLE
Resident foreign patients receive adequate dialysis but fewer preemptive transplantations: data from the Italian pediatric dialysis registry Fabio Paglialonga 1 & Silvia Consolo 1 & Enrico Vidal 2 & Mattia Parolin 3 & Bruno Minale 4 & Mario Giordano 5 & Isabella Guzzo 6 & Chiara Benevenuta 7 & Rosa Roperto 8 & Ciro Corrado 9 & Francesca Mencarelli 10 & Roberto Chimenz 11 & Ilse-Maria Ratsch 12 & Giovanni Pieri 13 & Giovanni Montini 1,14 & Alberto Edefonti 1 & Enrico Verrina 15 Received: 26 May 2020 / Revised: 15 July 2020 / Accepted: 27 July 2020 # IPNA 2020
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.
Keywords Pediatric dialysis . Preemptive transplantation . Dialysis choice . Foreign patients . Kidney replacement therapy
Introduction Racial ethnic disparities have been well documented in children with kidney failure needing kidney replacement therapy (KRT) both in North America and Europe [1–7]. Some recent studies have shown that children with immigrant parents or
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04730-0) contains supplementary material, which is available to authorized users. * Fabio Paglialonga [email protected] Extended author information available on the last page of the article
from ethnic minorities have lower access to transplantation (Tx), and, in case of dialysis, hemodialysis (HD) is
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