Backgroud Hemolytic uremic syndrome (HUS) is a life-threatening disease with a poor prognosis in children receiving maintenance renal replacement therapy (RRT). The aim of this study was to analyse the incidence and outcome of chronic kidney disease stage 5 (CKD5) due to Escherichia coli-HUS (STEC-HUS) and complement-mediated HUS (CM-HUS) in children, compared to controls with non-HUS CKD5 over the last 24 years.
Methods The study included 1,488 children undergoing RRT in Poland between 2000 and 2023. Thirty-nine patients with CM-HUS and 18 with STEC-HUS were identified and analysed for incidence, RRT modality and survival.
Results The incidence rate of CKD5 was 0.09 cases/million age-related population (marp) for STEC-HUS and 0.23/marp for CM-HUS, while no new cases have been observed in recent years. CKD5 due to CM-HUS developed significantly earlier from initial HUS manifestation than in STEC-HUS (median 0,2 year vs. 9,8years). CM-HUS was associated with a younger age at initiation of RRT compared to STEC-HUS and non-HUS controls (median 6.0 years vs. 10.9 and 10.9 years), with a higher risk of death (Hazard Ratio 1.92, 95% Confidence Interval 0.9 - 4.13) and worse 5-year kidney graft survival at 77%, 93% and 90%, respectively (p<0.001).
Conclusions In recent years, both CM-HUS and STEC-HUS, have become an increasingly rare causes of CKD5 in children. In the eculizumab era CKD5 due to CM-HUS is exceptional. Children on RRT due to STEC-HUS had a significantly better survival, shorter waiting time for kidney transplantation and better kidney graft survival compared to the CM-HUS group.