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Original article

Vol. 150 No. 3132 (2020)

Paediatric end-stage renal disease and renal replacement therapy in Switzerland: survival and treatment trends over four decades

Cite this as:
Swiss Med Wkly. 2020;150:w20300



Renal replacement therapy for paediatric end-stage renal disease (ESRD) has developed steadily since its introduction five decades ago. Continuous and long-term analysis of patient outcomes is essential for quality control.


The Swiss Paediatric Renal Registry, founded in 1970, includes patients diagnosed with ESRD, defined as dialysis for more than three months or renal transplantation, at age <20 years. Here we describe the incidence, primary renal disease, treatment modalities and long-term outcomes over 45 years.


This paper reports on 367 children and adolescents treated with chronic renal replacement therapy in Switzerland. Incidence was 5.4 per million children per year, with a tendency to increase over time. The primary renal disease was congenital anomalies of the kidney and the urinary tract in 133 (36%), monogenetic hereditary diseases in 122 (33%) and acquired diseases in 112 (31%) patients. The first renal replacement therapy was haemodialysis in 194 (53%), peritoneal dialysis in 116 (32%) and pre-emptive renal transplantation in 57 (15%) patients. Over the years, pre-emptive renal transplantation became more frequent (34% of all first renal replacement therapies in 2006–2015), reducing the duration of dialysis. Median time on dialysis until transplantation decreased from 1.60 years in 1981–90 to 0.34 years in 2010–15. Over the four decades 1970–80, 1981–90,1991–2000 and 2001–10, the one-year graft survival rate improved from 0.76 to 0.80, 0.89 and then 0.96; and the five-year graft survival rate improved from 0.44 to 0.64, 0.84 and 0.89, respectively. The five-year patient survival rates for the four decades were 0.83, 0.99, 0.93 and 0.94; and the 10-year patient survival rates were 0.75, 0.96, 0.88 and 0.94, respectively. In the four cohorts starting renal replacement therapy in the 70s, 80s, 90s and 00s, the number of children alive after five years of renal replacement therapy increased from 15 to 24, 47 and then 45 respectively. In total, 29 patients (8%) died during chronic renal replacement therapy with ESRD before the age of 20 years.


Over time, a higher number of children on renal replacement therapy survived, graft survival improved, and the duration of dialysis before renal transplantation decreased.


  1. Rees L. Long-term outcome after renal transplantation in childhood. Pediatr Nephrol. 2009;24(3):475–84. doi:.
  2. Falger J, Latal B, Landolt MA, Lehmann P, Neuhaus TJ, Laube GF. Outcome after renal transplantation. Part I: intellectual and motor performance. Pediatr Nephrol. 2008;23(8):1339–45. doi:.
  3. Falger J, Landolt MA, Latal B, Rüth EM, Neuhaus TJ, Laube GF. Outcome after renal transplantation. Part II: quality of life and psychosocial adjustment. Pediatr Nephrol. 2008;23(8):1347–54. doi:.
  4. Mekahli D, Shaw V, Ledermann SE, Rees L. Long-term outcome of infants with severe chronic kidney disease. Clin J Am Soc Nephrol. 2010;5(1):10–7. doi:.
  5. Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L. Outcome and growth of infants with severe chronic renal failure. Kidney Int. 2000;57(4):1681–7. doi:.
  6. Schaefer F, Doyon A, Azukaitis K, Bayazit A, Canpolat N, Duzova A, et al.; 4C Study Consortium. Cardiovascular Phenotypes in Children with CKD: The 4C Study. Clin J Am Soc Nephrol. 2017;12(1):19–28. doi:.
  7. McDonald SP, Craig JC ; Australian and New Zealand Paediatric Nephrology Association. Long-term survival of children with end-stage renal disease. N Engl J Med. 2004;350(26):2654–62. doi:.
  8. Smith JM, Martz K, Blydt-Hansen TD. Pediatric kidney transplant practice patterns and outcome benchmarks, 1987-2010: a report of the North American Pediatric Renal Trials and Collaborative Studies. Pediatr Transplant. 2013;17(2):149–57. doi:.
  9. Smith JM, Dharnidharka VR. Viral surveillance and subclinical viral infection in pediatric kidney transplantation. Pediatr Nephrol. 2015;30(5):741–8. doi:.
  10. Mynarek M, Hussein K, Kreipe HH, Maecker-Kolhoff B. Malignancies after pediatric kidney transplantation: more than PTLD? Pediatr Nephrol. 2014;29(9):1517–28. doi:.
  11. van der Heijden BJ, van Dijk PC, Verrier-Jones K, Jager KJ, Briggs JD. Renal replacement therapy in children: data from 12 registries in Europe. Pediatr Nephrol. 2004;19(2):213–21. doi:.
  12. Tizard EJ, Verrina E, van Stralen KJ, Jager KJ. Progress with the European Society for Paediatric Nephrology (ESPN)/ERA-EDTA Registry for children with established renal failure (ERF). Nephrol Dial Transplant. 2009;24(9):2615–7. doi:.
  13. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012;27(3):363–73. doi:.
  14. Chesnaye N, Bonthuis M, Schaefer F, Groothoff JW, Verrina E, Heaf JG, et al.; ESPN/ERA–EDTA registry. Demographics of paediatric renal replacement therapy in Europe: a report of the ESPN/ERA-EDTA registry. Pediatr Nephrol. 2014;29(12):2403–10. doi:.
  15. Harambat J, Bonthuis M, Groothoff JW, Schaefer F, Tizard EJ, Verrina E, et al. Lessons learned from the ESPN/ERA-EDTA Registry. Pediatr Nephrol. 2016;31(11):2055–64. doi:.
  16. Deleau J, Andre JL, Briancon S, Musse JP. Chronic renal failure in children: an epidemiological survey in Lorraine (France) 1975-1990. Pediatr Nephrol. 1994;8(4):472–6. doi:.
  17. Esbjörner E, Berg U, Hansson S ; Swedish Pediatric Nephrology Association. Epidemiology of chronic renal failure in children: a report from Sweden 1986-1994. Pediatr Nephrol. 1997;11(4):438–42. doi:.
  18. Ardissino G, Daccò V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, et al.; ItalKid Project. Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics. 2003;111(4):e382–7. doi:.
  19. Bek K, Akman S, Bilge I, Topaloğlu R, Calişkan S, Peru H, et al. Chronic kidney disease in children in Turkey. Pediatr Nephrol. 2009;24(4):797–806. doi:.
  20. Mong Hiep TT, Ismaili K, Collart F, Van Damme-Lombaerts R, Godefroid N, Ghuysen MS, et al. Clinical characteristics and outcomes of children with stage 3-5 chronic kidney disease. Pediatr Nephrol. 2010;25(5):935–40. doi:.
  21. Gämperli A, Leumann E, Neuhaus TJ, Schlumpf R, Largiadèr F. [25 years of dialysis and kidney transplantation in children and adolescents]. Schweiz Med Wochenschr. 1996;126(3):77–85. Article in German.
  22. Chesnaye NC, van Stralen KJ, Bonthuis M, Harambat J, Groothoff JW, Jager KJ. Survival in children requiring chronic renal replacement therapy. Pediatr Nephrol. 2018;33(4):585–94. doi:.
  23. Leumann E, Goetschel P, Neuhaus TJ, Ambühl PM, Candinas D. [Pediatric kidney transplantation and living donors--invaluable by virtue of necessity]. Schweiz Med Wochenschr. 2000;130(43):1581–9. Article in German.
  24. Weitz M, Sazpinar O, Schmidt M, Neuhaus TJ, Maurer E, Kuehni C, et al. Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function? Transpl Int. 2017;30(1):68–75. doi:.
  25. [Internet]. Neuchatel: Federal Statistical Office, Switzerland. Annual population statistics 1981 - 2010 (ESPOP), and Population and Households Statistics 2011 - 2015 (STATPOP). C2019 [cited 2019 Sep 27]. Available from:
  26. UK Renal Registry [Internet]. Bristol: UK Renal Registry 21st Annual Report – data to 31/12/2017; Chapter 7, Children un renal replacement therapy (RRT) for end-stage kidney disease (ESKD) in the UK in 2017; c2019 [cited 2020 Apr 19]. Available from:
  27. Goldstein SL. Advances in pediatric renal replacement therapy for acute kidney injury. Semin Dial. 2011;24(2):187–91. doi:.
  28. [Internet]. Rockville: Martz K, Stablein DM, Berlin S, Wright R, Fraser G, Thotapally K. North American Pediatric Renal Trials and Collaborative Studies, NAPRTCS, 2008 Annual Report; c2019 [cited 2019 Sep 27]. Available from:
  29. [Internet]. Amsterdam: van Stralen KJ, Verrina E, Schaefer F, Jager K. ESPN/ERA-EDTA registry annual report 2008; c2019 [cited 2019 Sep 27]. Available from:
  30. [Internet]. Adelaide: McTaggart S MS, Henning P, Dent H. Paediatric Report. ANZDATA Registry Report 2009, Australia and New Zealand Dialysis and Transplant Registry; c2019 [cited 2019 Sep 27]. Available from:
  31. Moncrief JW, Popovich RP, Nolph KD. The history and current status of continuous ambulatory peritoneal dialysis. Am J Kidney Dis. 1990;16(6):579–84. doi:.
  32. Feber J, Schärer K, Schaefer F, Míková M, Janda J. Residual renal function in children on haemodialysis and peritoneal dialysis therapy. Pediatr Nephrol. 1994;8(5):579–83. doi:.
  33. Harambat J, van Stralen KJ, Schaefer F, Grenda R, Jankauskiene A, Kostic M, et al. Disparities in policies, practices and rates of pediatric kidney transplantation in Europe. Am J Transplant. 2013;13(8):2066–74. doi:.
  34. Kramer A, Stel VS, Tizard J, Verrina E, Rönnholm K, Pálsson R, et al. Characteristics and survival of young adults who started renal replacement therapy during childhood. Nephrol Dial Transplant. 2009;24(3):926–33. doi:.
  35. Gillen DL, Stehman-Breen CO, Smith JM, McDonald RA, Warady BA, Brandt JR, et al. Survival advantage of pediatric recipients of a first kidney transplant among children awaiting kidney transplantation. Am J Transplant. 2008;8(12):2600–6. doi:.
  36. Verghese PS. Pediatric kidney transplantation: a historical review. Pediatr Res. 2017;81(1-2):259–64. doi:.
  37. Rees L, Shroff R, Hutchinson C, Fernando ON, Trompeter RS. Long-term outcome of paediatric renal transplantation: follow-up of 300 children from 1973 to 2000. Nephron Clin Pract. 2007;105(2):c68–76. doi:.
  38. Pitcher GJ, Beale PG, Bowley DM, Hahn D, Thomson PD. Pediatric renal transplantation in a South African teaching hospital: a 20-year perspective. Pediatr Transplant. 2006;10(4):441–8. doi:.
  39. Groothoff JW, Cransberg K, Offringa M, van de Kar NJ, Lilien MR, Davin JC, et al.; Dutch cohort study. Long-term follow-up of renal transplantation in children: a Dutch cohort study. Transplantation. 2004;78(3):453–60. doi:.
  40. Englund M, Berg U, Tydén G. A longitudinal study of children who received renal transplants 10-20 years ago. Transplantation. 2003;76(2):311–8. doi:.
  41. Mehrabi A, Kashfi A, Tönshoff B, Feneberg R, Mehls O, Schemmer P, et al. Long-term results of paediatric kidney transplantation at the University of Heidelberg: a 35 year single-centre experience. Nephrol Dial Transplant. 2004;19(Suppl 4):iv69–74. doi:.
  42. Van Damme-Lombaerts R, Herman J, Coosemans W, Pirenne J. Pediatric renal transplantation: a single Belgian center experience over 20 years. Pediatr Transplant. 2001;5(6):447–51. doi:.
  43. Parekh RS, Carroll CE, Wolfe RA, Port FK. Cardiovascular mortality in children and young adults with end-stage kidney disease. J Pediatr. 2002;141(2):191–7. doi:.
  44. Groothoff JW, Gruppen MP, Offringa M, Hutten J, Lilien MR, Van De Kar NJ, et al. Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int. 2002;61(2):621–9. doi:.
  45. Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood. Nephrol Dial Transplant. 2013;28(8):2082–9. doi:.
  46. Mong Hiep TT, Janssen F, Ismaili K, Khai Minh D, Vuong Kiet D, Robert A. Etiology and outcome of chronic renal failure in hospitalized children in Ho Chi Minh City, Vietnam. Pediatr Nephrol. 2008;23(6):965–70. doi:.
  47. Gulati S, Mittal S, Sharma RK, Gupta A. Etiology and outcome of chronic renal failure in Indian children. Pediatr Nephrol. 1999;13(7):594–6. doi:.

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