PRIMARY DIAGNOSIS OF END-STAGE KIDNEY DISEASE (ESKD) AT FIRST DIALYSIS TREATMENT AMONG PEDIATRIC AND YOUNG ADULTS FROM FOUR WORLD REGIONS: AN INTERNATIONAL REPORT FROM THE MONDO INITIATIVE

Introduction:

While older adults with ESKD commonly face diabetes and hypertension, pediatric and young adult populations show distinct patterns. However, comprehensive epidemiological data from multiple regions are limited. This study explores ESKD etiologies in younger patients using the multinational MONitoring Dialysis Outcomes (MONDO) database and contrasts these patterns with those typically observed in older adults.

Methods:

We analyzed patients aged 0-40 years from the MONDO database (2003-2012), segmented into five age groups: ≤12, >12 to ≤18, >18 to ≤26, >26 to ≤33, and >33 to ≤40 years. We included all dialysis modalities. ESKD etiologies were classified based on ICD-9 and ICD-10 codes into six categories: Diabetes, Congenital Anomalies of the Kidney and Urinary Tract (CAKUT), Urinary, Glomerular, Other, and Unknown. Data were reported in frequencies and analyzed using R Studio 4.3.3.

Results:

The study included 22,029 patients from 30 countries and four regions: North America (4.5%), Latin America (28%), Europe (41%), and Asia-Pacific (26%). Predominantly, patients underwent HD (84.2%), with 15.2% on hemodiafiltration, especially in Asia-Pacific and Europe. Key demographics: 12,988 males (59%), mean age 29.9 ± 7.6 years. The majority (40%) were aged >33 to ≤40 years, 22% were >18 to ≤26, 6.6% were >12 to ≤18, and 2.1% were ≤12 years. Race data for 60% showed 53% White, 24% Asian, 8.1% Black, and 16% Other. ESKD etiology was most commonly unknown (38%), followed by glomerular disorders (35%), other causes (34%), diabetes (9.9%), urinary disorders (7.5%), and CAKUT (2.3%). CAKUT was more prevalent in the ≤12 age group (15%), while diabetes rose sharply post-adolescence, from 0.7% to 4.2% (Figure1). Regionally, outpatient pediatric dialysis was more common in Latin America (8.9%) and North America (8.4%) compared to Asia-Pacific (6.2%) and Europe (5.2%).

Conclusions:

In this MONDO sub-cohort, most patients were aged >33 to ≤40 years, with unknown etiology being the most common cause of ESKD. Pediatric patients predominantly came from the Americas and exhibited different ESKD etiologies, notably CAKUT and glomerular disorders, compared to older adults. These findings underscore global collaboration's importance in deepening our understanding of age- and region-specific ESKD patterns. Enhanced multi-regional data collection and analysis are vital for developing tailored interventions and improving long-term outcomes for young patients on sustained dialysis.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.