The clinical epidemiology of young adults starting renal replacement therapy in the UK: presentation, management and survival using 15 years of UK Renal Registry data

Background: Clinical epidemiology data for young adults on renal replacement therapy (RRT) is lacking. Whilst mostly transplanted, they have an increased risk of graft loss during young adulthood. Methods: We combined the UK Renal Registry paediatric and adult databases to describe patient characteristics, transplantation and survival for young adults. We grouped patients aged 11 to 30 years starting RRT from 1999 to 2008 by age band and examined their course during 5 years follow-up. Results: The cohort (n=3370) was 58% male, 79% white and 29% had glomerulonephritis. Half (52%) started RRT on haemodialysis. Most (78%) were transplanted (18% pre-emptive, 61% as second modality), 11% were not listed for transplant. Transplant timing varied by age group. The deceased to living kidney transplant ratio was 2:1 for 11 to <16 year olds and 1:1 otherwise. Median deceased donor transplant waiting times ranged from 6 months if aged <16 years to 17 months if aged ≥21 years. Overall 8% died, with being on dialysis and not transplant listed versus transplanted [hazard ratio 17.6 (4.36 – 70.9), p<0.0001] and diabetes versus glomerulonephritis [hazard ratio 4.48 (3.05 - 6.58), p<0.0001] increasing mortality risk. Conclusions: This study highlights frequent use of haemodialysis and the importance of transplant listing and diabetes for young adults.