Long-term outcome of chronic dialysis in children

Abstract

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.

Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

“…Maintenance dialysis duration in our study, median 1.46 years, range 0.25–17.54 years, and mean 2.48 ± 3.02 years, was similar to that in centers in Europe and USA [6, 8, 28] despite the limited graft sources in a small country such as Israel. The limited amount of potential donors in Israel can be explained by various religious beliefs causing individuals not to donate organs.…”

“…PD is known to have several advantages over HD in children, including better preservation of native renal function, lack of long-term compromise of the main venous vascular tree, and freedom from frequent hospital visits with significantly less interference with everyday life activities and quality of life. Nevertheless, only 35% of our patients were started on PD compared to 80% in other series [8]; this can be explained by the reasonable travel distances to the pediatric dialysis unit from most parts of our country; therefore patients who cannot be managed with PD at home are easily switched to HD when it is in their best interest. Furthermore, 67% of our cohort were adolescents, many of whom may have declined PD because of its major impact on body image.…”

“…Previous studies described smaller cohorts of 34 [27] and 98 children [8] with shorter follow-up times of 9 and 14 years, respectively. Males were slightly overrepresented in our study (57.3% versus 42.7% for females), in agreement with findings that ESRD is more common in males [6, 21, 22, 24, 25].…”

Nutrition in children with CRF and on dialysis

“…Increasing severity of CRF adversely affects growth: when the patients were divided into those with a GFR greater or less than 25 ml/min/1.73 m 2 , the HtSDS was −1.65 and −2.79, respectively [44]. Reports of growth on dialysis vary from improvement [54], to no change [55] to declining HtSDS [56], with a worsening of nutritional status in children dialysed for more than a year [50]. …”

“…Our impression is that spontaneous oral intake increases with long-term tube feeding; indeed, over a period of 31 months energy intake from the feed did not increase, implying that oral intake had improved over this time to support the demonstrated growth [21]. Reports of the use of Nissen fundoplication are principally from one group [21, 47, 54, 79, 88, 92], making assessment of its effect difficult, although results of growth from this centre are good.…”