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The Demographics of Pediatric Dialysis

End-stage renal disease (ESRD) is not a common pediatric disorder. In the United States and Canada, there are about 11 new pediatric ESRD cases per million children of similar age reported each year (1, 2). In contrast, the incidence of congenital heart disease is 8,000 per million, and that of childhood leukemia is 40 per million (3 ,4) . The incidence of ESRD in pediatric patients also shows marked geographic variability, ranging from 2.1 to >10 new cases per million children per year in various parts of the world ( 5 ) . For example, the European Dialysis and Transplant Association (EDTA) reports the mean pediatric ESRD incidence for all member countries considered together to be 4.6 new patients per million children per year; however, national incidence rates vary from 2 per million in Turkey to 12.5 per million in Finland ( 5 ) . It is doubtful that such differences reflect actual geographic differences in the prevalence of diseases and conditions that result in ESRD in children, although this has not been systematically studied. Rather, the observed geographic variability in ESRD incidence appears more likely to be the result of differences in economic and social conditions (5 ) . ESRD incidence also varies according to patient age at initiation of renal replacement therapy (RRT). Data from the United States Renal Data System (USRDS) show that ESRD incidence increases dramatically with increasing patient age (6). However, even among the oldest pediatric age group (15to 19-year-olds) the incidence of ESRD is less than one-third of that seen in the youngest adult ESRD patients (Table 1) (6). Table 1 also shows how pediatric ESRD incidence can vary over time. Note that in 1977 only two infants (less than one year of age) per million began RRT, compared with 15 per million a decade later. Substantial, though less dramatic, increases are seen for the next two age groups, while above nine years of age the incidence of pediatric ESRD remained essentially unchanged between 1977 and 1987. These data could be interpreted to show that, between 1977 and 1987, an absolute increase in renal disease occurred in children <10 years of age, but it is more likely that, by 1987, younger children