European disparities in the incidence and outcomes of children with end-stage renal disease

Research output: PhD ThesisPhd-Thesis - Research and graduation internal

Abstract

In this thesis, we primarily aim to reveal health inequalities and improve outcomes in the European paediatric renal replacement therapy (RRT) population. Despite commitments and progress made by European Union Member States towards reducing health inequalities, we demonstrate that geographical disparities regarding the quality and provision of RRT to children have yet to be eliminated across Europe, especially regarding the acceptance and treatment of the youngest patients, whom are the most complex and costly to treat. As a secondary objective, we describe the mortality risk in the paediatric dialysis population, and investigate the effect of initial dialysis modality on mortality risk, focussing on the infant dialysis population. We identify an initial survival advantage for those selected to initiate dialysis on PD, especially in children with a limited time under treatment of a nephrologist prior to dialysis, and in children over 5 year years of age. Lastly, to help optimize kidney donor allocation policies, we examined how the relationship between donor age and recipient age affects graft survival in paediatric kidney transplant recipients. We demonstrate that grafts from carefully selected older donors offer excellent graft survival probabilities in paediatric recipients. When a living donor is unavailable, the differential graft failure risk of deceased donor age and recipient age should be taken into account during the allocation process. Specifically, transplantation of the youngest deceased donors should be avoided in the youngest recipients, as graft failure rates in this group were especially high, particularly directly post-transplantation.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
Supervisors/Advisors
  • Jager, Kitty, Supervisor
  • van Stralen, K.J., Co-supervisor, External person
Award date1 Dec 2017
Publication statusPublished - 2017

Cite this