Timing of Kidney Replacement Therapy among Children and Young Adults

Background No randomized trials exist to guide the timing of the initiation of KRT in children. We sought to define trends and predictors of the eGFR at initiation of KRT, center-related clinical practice variation, and any association with patient survival.Methods Children and young adults (1–25 years) commencing KRT (dialysis or kidney transplantation) between 1995 and 2018 were included using data from the Australia and New Zealand Dialysis and Transplant Registry.The associations between eGFR on commencing KRT and covariates were estimated using quantile regression. Cox regression was used to estimate the association between eGFR and patient survival. Logistic regression,categorizing eGFR about a value of 10 ml/min per 1.73 m2, was used in conjunction with a random effect by center to quantify clinical practice variation.Results Overall, 2274 participants were included. The median eGFR at KRT initiation increased from 7 to 9 ml/min per 1.73 m2 over the study period and the 90th centile from 11 to 17 ml/min per 1.73 m2. The effect of era on median eGFR was modified by modality, with a greater increase among those receiving a preemptive kidney transplant (1.0 ml/min per 1.73 m2 per 5 years; 95% confidence interval [CI], 0.6 to 1.5) or peritoneal dialysis (0.7ml/min per 1.73 m2 per 5 years; 95% CI, 0.4 to 0.9) compared with hemodialysis (0.1 ml/min per 1.73 m2 per 5years; 95% CI, 20.1 to 0.3). There were 252 deaths (median follow-up 8.5 years, interquartile range 3.7–14.2) and no association between eGFR and survival (hazard ratio, 1.01 per ml min per 1.73 m2; 95% CI, 0.98 to 1.04). Center variation explained 6% of the total variance in the odds of initiating KRT earlier. This rose to over 10% when comparing pediatric centers alone.Conclusions Children and young adults progressively commenced KRT earlier. This change was more pronounced for children starting peritoneal dialysis or receiving a preemptive kidney transplant. Earlier initiation of KRT was not associated with any difference in patient survival. A substantial proportion of clinical practice variation was due to center variation alone.The unprecedented circumstances created by the COVID-19 pandemic significantly changed the usual processes of work throughout the creative industries. In case of theatre, the companies could no longer perform in the usual facilities and rehearsals were restricted. Theatre artists reacted differently to the new conditions dictated by the COVID-19 pandemic. Facing restrictions of working in contact mode some sought ways to adapt and not only create but also present performances to audiences online, others chose to deny the forms of mediatized theatre, as if waiting for the times to change. The aim of this article is to review the dynamics of theatre attendance in Lithuania in the 2018–2020 period. Data from yearly reports of state funded theatres reveal how many viewers visited Lithuanian theatres physically and how many performances were watched online. The analysis of this data provides an insight into the changes in the number of viewers compared to the pre-COVID-19-pandemic years and answers the question of whether performances on Internet platforms attracted a significant number of online audiences. The results of the analysis are indicative of the sustainability of the demand for views of performances online.