Analysis of Pediatric vs. Adult Patients with ESRD Using Peritoneal Dialysis (PD) and Kidney Transplantation from Real-World IPRO Data

Background: Pediatric end-stage renal disease presents distinct clinical and psychosocial challenges due to ongoing growth, developmental needs, and long-term health implications. Treatment options include hemodialysis, peritoneal dialysis, and kidney transplantation. Selecting an appropriate initial modality and ensuring timely transitions is critical to optimizing both survival and quality of life in this vulnerable population. This study analyzes trends in modality utilization among pediatric ESRD patients compared to adults. Methods: This retrospective analysis included data from 252,075 ESRD patients across the New England, New York, South Atlantic, and Ohio River regions from 2018 to 2024 through the IPRO ESRD Network. A descriptive analysis was conducted using medians (range) for continuous variables and frequencies (percentages) for categorical variables. Multivariable Cox regression was applied to assess age-related differences in outcomes. Results: Pediatric patients comprised only 0.65% of the ESRD population. However, their initial treatment approaches differed significantly. Compared to adults, more started on PD (11% vs. 31%) or were preemptively listed for transplant (3% vs. 23%). Pediatric patients also had a lower failure rate for PD, 24.8% compared to 68.9% in adults by year 5. lnitial transplant rates were similar (<1%), but pediatric patients had much faster access to transplant, with 22.4% receiving a kidney within the first year of HD or being listed, compared to 2.8% of adults. The rate of transplant for the pediatric population increased drastically to 53.3% at year 3 and 61.7% at year 5, while by year 5 only 16.2% of adults receive a transplant. Conclusion: Pediatric ESRD care tends to prioritize quality of life through early PD use and quicker access to transplant. Given the long-term implications, this model may be better suited for pediatric needs. Further research should explore barriers to broader PD and transplant use, such as caregiver support and provider comfort, to help improve outcomes.