Recent advances in pediatric dialysis: a review of selected articles (original) (raw)
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Challenges and Outcomes of Chronic Dialysis in Children: A Narrative Review
Journal of pharmaceutical research international, 2024
Chronic dialysis is a life-saving treatment for children with end-stage renal disease (ESRD). However, it comes with difficult challenges, cardiovascular ones being the most significant and fatal. Chronic kidney disease-mineral bone disorder (CKD-MBD) is also a common complication of chronic dialysis, as it has significant effects on growth and cardiovascular health. Infections are also a significant problem for those on chronic dialysis. The cost of dialysis and the lifestyle of Children with CKD are also not optimal, as they have a significantly lower Health-related quality of life (HRQoL) than children with other chronic illnesses. Children on chronic dialysis face several difficult challenges, which differ between peritoneal dialysis (PD) and hemodialysis (HD). Most of these challenges are manageable or preventable. This review article will discuss some of the challenges that children and their families encounter during chronic dialysis strategies to manage these challenges and the outcomes of long-term kidney dialysis.
Long-term outcome of chronic dialysis in children
Pediatric Nephrology, 2009
As the prevalence of children on renal replacement therapy (RRT) increases world wide and such therapy comprises at least 2% of any national dialysis or transplant programme, it is essential that paediatric nephrologists are able to advise families on the possible outcome for their child on dialysis. Most children start dialysis with the expectation that successful renal transplantation is an achievable goal and will provide the best survival and quality of life. However, some will require long-term dialysis or may return intermittently to dialysis during the course of their chronic kidney disease (CKD). This article reviews the available outcome data for children on chronic dialysis as well as extrapolating data from the larger adult dialysis experience to inform our paediatric practice. The multiple factors that may influence outcome, and, particularly, those that can potentially be modified, are discussed.
Growth of children following the initiation of dialysis: a comparison of three dialysis modalities
Pediatric Nephrology, 1994
Maintenance dialysis usually serves as an interim treatment for children with end-stage renal disease (ESRD) until transplantation can take place. Some children, however, may require dialytic support for an extended period of time. Although dialysis improves some of the problems associated with growth failure in ESRD (acidosis, uremia, calcium, and phosphorus imbalance), many children continue to grow poorly. Therefore, three different dialysis modalities, continuous ambulatory peritoneal dialysis (CAPD), cycler/intermittent peritoneal dialysis (CPD), and hemodialysis (HD), were evaluated with regard to their effects on the growth of children initiating dialysis and remaining on that modality for 6-12 months. Growth was best for children undergoing CAPD when compared with the other two modalities with regard to the following growth parameters: incremental height standard deviation score for chronological age [-0.55-t-2.06 vs. -1.69 • 1.22 for CPD (P <0.05) and-1.80___ 1.13 for HD (P <0.05)]; incremental height standard deviation score for bone age [-1.68+_1.71 vs. -2.45___1.43 for CPD (P = NS) and -2.03 __ 1.28 for HD (P = NS)]; change in height standard deviation score during the dialysis period [0.00_ 0.67 vs. ~0.15__.29 for CPD (P = NS) and -0.23+_.23 for HD (P = NS)]. The reasons why growth appears to be best in children receiving CAPD may be related to its metabolic benefits: lower levels of uremia, as reflected by the blood urea nitrogen [50___ 12 vs. 69__ 16 mg/dl for CPD (P <0.5) and 89 • 17 for HD (P < 0.05)], improved metabolic acidosis, as indicated by a higher serum bicarbonate concentration [24 ___ 2 mE@ vs. 22 • 2 for CPD (P < 0.05) and 21 ___ 2 for HD (P < 0.05)]. In addition, children undergoing CAPD receive significant supplemental calories from the glucose absorbed during dialysis. CAPD, and possibly, other types of prolonged-dwell daily peritoneal dialysis Correspondence to:
Chronic dialysis in children and adolescents
Pediatric Nephrology, 1999
The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) summarizes data submitted from 130 centers on 2,208 patients in whom 2,787 independent courses of dialysis were performed between 1 January 1992 and 16 January 1996. Approximately two-thirds of the dialysis population were maintained on peritoneal dialysis (PD), with automated PD remaining the preferred modality. There were 964 episodes of peritonitis in 1,018 patient years, yielding an overall peritonitis rate of 1 episode every 13 patient months. More PD patients attended school full time than hemodialysis (HD) patients at baseline (77% vs. 45%), which continued at 6, 12, and 24 months of followup. There were fewer Hispanic patients who were full-time students, whether on HD or PD, compared with white or black patients; 18% of Hispanic patients did not attend school, even though they were medically capable. The majority of dialysis courses terminated due to transplantation (54%), with change in dialysis modality the next most-common reason (28%). Early dialysis termination for any reason was seen more often in HD than PD (40% vs. 23% at 6 months), but by 24 months similar percentages of PD and HD courses had been terminated (75% HD, 72% PD). The mostcommon PD access was a Tenckhoff catheter with a single cuff, a straight tunnel and lateral exit site. The majority of HD accesses were external percutaneous catheters, with the sublcavian vein the most-common site. Erythropoietin was administered in 93% of HD and PD patients at 24 months. & k w d : Key words Peritoneal dialysis • Hemodialysis • End-stage renal disease& b d y : Patients and methods Methods The information comprising the 1996 NAPRTCS annual report was derived from the voluntary participation of 130 NAPRTCS pediatric dialysis centers in the United States, Canada, Mexico, and Costa Rica. An initial registration form was completed for each patient entering the registry and was then followed at 30 days after initiation, 6 months after initiation, and every 6 months thereafter by followup status forms. Modality initiation forms were submitted for 2,787 independent courses of dialysis. An independent course of dialysis is defined to have occurred when a patient
Pediatric Nephrology, 2001
The Health Care Financing Administration (HCFA) has gathered clinical data on end stage renal disease (ESRD) patients since 1994, but details are only available on patients ≥18 years. In this report, we present morbidity data collected prospectively over 12 months from all children (1-18 years) maintained on either hemodialysis (HD) or peritoneal dialysis (PD) within the six-state New England area. During this year, 17 observations were recorded on 14 HD patients (age 13.4± 11.3 years) and 36 observations were made on 25 PD patients (age 11.5±4.8 years; mean ± SD). These patients were generally highly functional, attending school at least part time in nearly all cases. Dialysis adequacy index (DAI), defined as the delivered KT/V divided by DOQI guideline values, indicated that patients were well dia-
Revisiting the Chronic Renal Disease in Pediatric Patients
International Journal of Health Sciences and Research, 2016
This paper aims to review the diagnosis, epidemiological data, etiology, pathophysiology and progression of Chronic Kidney Disease (CKD), with emphasis on pediatric patients. CKD is defined as a group of structural and functional kidney abnormalities observed for more than three months, which affects patient's health. CKD prevalence in children is lower than in adults, but is associated to cardiovascular diseases and has high mortality and morbidity rates. CKD-affected children have alterations in physical and psychological development, growth retardation and muscle weakness, among other complications which decrease patients’ quality of life. The main causes of CKD in children are congenital anomalies of the kidney and urinary tract, and primary glomerulopathy, especially focal segmental glomerulosclerosis. Some conditions contribute to CKD progression, such as responsiveness to treatment. The knowledge of the pathophysiology of CKD and disease progression mechanisms is importan...
American Journal of Kidney Diseases, 2000
Network 1 (New England) initiated the Clinical Indicator Project to survey dialysis adequacy (Kt/V), nutrition (serum albumin level), and anemia management in patients maintained on chronic dialysis. Because little information is available in children, data were specifically recorded covering these variables in patients (age, 1 to 18 years) maintained on either hemodialysis (HD) or peritoneal dialysis (PD). During the 18 months of data collection, 29 observations were recorded on 23 HD patients (age, 14.3 ؎ 3.6 years), and 43 observations were made on 30 PD patients (age ,10.6 ؎ 4.7 years). Kt/V correlated inversely with the age of the patient (HD, P < 0.004; PD, P < 0.0007). Although serum albumin level was not associated with dialysis adequacy in HD patients, there was a strong inverse relationship between albumin level and Kt/V in PD patients (P < 0.002). Hematocrit values were not significantly different in the two groups (HD, 31.0% ؎ 5.5% versus PD, 32.9% ؎ 4.8%) and could not be correlated with weekly erythropoietin dose. Weekly erythropoietin dose was directly related to patient age in both groups (HD, P < 0.05; PD, P < 0.02). The weekly erythropoietin dosage needed to maintain the hematocrit was greater in HD patients (HD, 11,211 ؎ 7,484 U versus PD, 3,790 ؎ 1,968 U; P < 0.0001). We conclude that (1) smaller children in both groups tend to have a greater Kt/V, (2) Kt/V greater than 2.75 in PD patients may not improve nutrition per se and could result in increased albumin losses, and (3) erythropoietin dosing appears to correlate best with patient size (age) rather than degree of anemia.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 2015
Growth failure is one of the most common and profound clinical manifestation of chronic kidney disease (CKD) in infants, children and adolescents. The aim of this study was to assess the nutritional status of Egyptian children with end-stage renal disease (ESRD) on regular hemodialysis (HD). The study included 50 Egyptian children with ESRD on regular HD, following-up at the Pediatric Nephrology unit, Cairo University. History, including dietary history, was taken for all patients and clinical examination was performed on all of them. Body weight, standing height, height or length SD score, the skin fold thickness, mid-arm circumference, mid-arm muscle circumference and mid-arm muscle circumference area were also assessed. The height of the patients was the most affected anthropometric parameter, as 78% of the patients were shorter (height SDS below -3). Body weight is less affected than height, as body weight SDS of 34% of patients was less than -3 SDS. In addition, the body mass i...