Late Referral to Paediatric Renal Failure Service Impairs Access to Pre-emptive Kidney Transplantation in Children

Background: Timing of referral to subspecialists may be a major determinant for access to adequate treatment. Kidney transplantation is the preferred modality of renal replacement therapy (RRT) in children. In adults, delayed referral from general physicians to nephrologists reduced access to kidney transplantation. This study investigated the association between timing of referral and the likelihood of pre-emptive kidney transplantation in children.

Methods: In this retrospective study, all patients in a tertiary paediatric nephrology centre were grouped according to first paediatric nephrologist visit (< or = 3 months prior to RRT was defined as 'late referral (LR)') and modality of first RRT. Descriptive, correlation and contingency statistics, Pearson's chi(2) test and logistic regression techniques were used for analysis.

Results: The median duration of nephrologists pre-RRT care of 111 children (50 girls and 61 boys; aged 8.0 years at first referral) was 1.5 (range 0-17.5) years. Thirty-two of 84 children who had their first visit >3 months prior to RRT were pre-emptively transplanted (38%), but only three of the 27 children with LR (11%; OR 4.9; 95% CI 1.37 to 17.7). Using a threshold of 12 months, the likelihood of pre-emptive kidney transplantation was still significantly influenced by timing of referral (OR 2.5; 95% CI 1.06 to 5.91).

Conclusions: LR of children with chronic kidney disease to paediatric nephrology centre impairs the likelihood of receiving a pre-emptive kidney transplant. Specialised care of at least 12 months before the need for RRT arises is needed to allow for identification of and completion of the medical investigation of the living donor. Further studies using larger multicentre registries are needed to validate these single centre data.