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[Comment] Optimising care for children with kidney disease

The theme for World Kidney Day in 2016 was “kidney disease and children: act early to prevent it”. Given the adverse effect of renal replacement therapy—dialysis and transplantation—on quality of life and health care resources, few would disagree with this ambition. For some children, however, end-stage kidney disease cannot be avoided and its effects have to be managed and outcomes optimised. With increasing fiscal pressures on health services in many settings around the world, the Article in The Lancet by Nicholas Chesnaye and colleagues looking at macroeconomics and survival on renal replacement therapy in Europe is timely.