Dialysis in Israeli Children between 1990–2020: Trends and International Comparisons

Abstract

Background and objectives: 

Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pre-transplant course of the entire Israeli pediatric kidney failure population over 30 years.

Design, setting, participants, & measurements: 

In this nationwide, population-based, historical cohort study we analyzed medical and demographic data of all children treated with kidney-replacement therapy and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity and calendar year, using the appropriate age-related general population as denominator.

Results: 

During the last 30 years, childhood incidence of kidney failure has decreased. Average incidence in 2015-2019 is 9.1 cases per-million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews) and higher than in most Western countries. The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary-tract (∼27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type-1 (33%). Israel’s national-health insurance provides access to primary health-care to all citizens. Accordingly, waiting time for cadaveric transplantation was equal between all ethnicities. Living donor kidney transplantation rates among minorities remained low in comparison to Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent.

Conclusions: 

In Israel, Arab and Druze children have a higher incidence of kidney failure, a unique etiological distribution and a lower rate of living-donor kidney transplantations compared to Jewish children.