Hospitalization burden in children on dialysis: insights from the Italian Registry of Pediatric Chronic Dialysis (IRPCD)

BACKGROUND: Children receiving kidney replacement therapy frequently face complications resulting in recurrent hospitalizations. This nationwide retrospective observational study, conducted using data from the Italian Registry of Pediatric Chronic Dialysis (IRPCD), aimed to compare hospitalization rates and causes between children treated with chronic peritoneal dialysis (PD) and hemodialysis (HD). METHODS: The study included children (< 18 years) on chronic PD or HD recorded between January 2000 and December 2019. Hospitalizations were defined as admissions involving at least one overnight stay, excluding those for dialysis initiation or kidney transplantation. Hospitalization causes were categorized as infectious and non-infectious dialysis-related complications, other infections, non-infectious conditions, diagnostic procedures, and complications related to kidney failure. RESULTS: A total of 847 dialysis patients (493 on PD, 354 on HD) were included. Among 813 patients, 420 (51.7%) were hospitalized, with PD accounting for 72.9% at the first hospitalization. Dialysis-related infections were the most common cause (24.3%), particularly in PD patients, followed by non-infectious medical conditions (17.3%) and kidney failure-related complications (14.9%). Cox modeling indicated a lower risk of hospitalization for HD compared to PD (aHR 0.75 [95%CI 0.65-0.87]), with HD showing a protective effect over time. HD patients also had a lower likelihood of treatment changes after one year compared to PD (aHR 0.29 [95%CI 0.10-0.81]). CONCLUSIONS: This study highlights the significant burden of hospitalization among children on chronic dialysis, with PD patients experiencing higher risks over time compared to HD. These findings underscore the need for targeted strategies to mitigate hospitalization risks in pediatric dialysis populations.