Outcome data on pediatric dialysis patients from the end-stage renal disease Clinical Indicators Project

Brem, Andrew S.; Lambert, Cynthia; Hill, Connie; Kitsen, Jenny; Shemin, Douglas

doi:10.1053/ajkd.2000.8975

Cited by 40 publications

(20 citation statements)

References 12 publications

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“…There are no comparable mortality data for children, but the Network 1 Clinical Indicators Project reporting on clinical morbidity in paediatric dialysis patients found that, in a small group of well-dialysed patients on either HD or PD, the exceeding of recommended adequacy guidelines did not influence morbidity [38]. Indeed, in children on PD, a Kt/V value of > 2.75 was associated with increased albumin losses, which may have an adverse effect on nutrition and growth [39].…”

Section: Peritoneal Dialysismentioning

confidence: 99%

Long-term outcome of chronic dialysis in children

et al. 2005

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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.

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Section: Peritoneal Dialysismentioning

confidence: 99%

Long-term outcome of chronic dialysis in children

et al. 2005

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“…This article is a direct result of the Health Care Quality Improvement Program initiated by the Center for Medicare/Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this contractor. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed peritoneal dialysis (PD) [5]. Most of these children use automated cycling PD, which probably accounts for the improved dialysis efficiency.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of protein malnutrition in children maintained on peritoneal dialysis

Brem

Lambert²,

Hill³

et al. 2002

Pediatr Nephrol

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A paucity of outcome measures exist for children, making evidence-based treatment guidelines difficult to establish. Serum albumin has been identified as a surrogate marker for nutritional status and morbidity/mortality in patients with end-stage renal disease (ESRD). We hypothesized that the prevalence of low serum albumin (<2.9 g/dl) in children on peritoneal dialysis (PD) may be greater, making this population at risk. Patient data were collected prospectively over 24 months (1999-2000) from all children (1-18 years) maintained on either hemodialysis (HD) or PD within the six-state New England area; 64 observations were made on 39 children on PD over the 2-year period. The mean age was 11.7+/-4.7 years (mean+/-SD). The prevalence of low serum albumin in children was 35.9% (23/64 observations) compared with 19.5% (712/3,719 observations) in adult Network ESRD patients on PD ( P<0.004). None of the 32 children (47 observations) maintained on HD exhibited low serum albumin during the data collection period. The prevalence of low serum albumin in adult HD patients was 5.5%. Dietary protein intake was estimated from a calculated protein catabolic rate (PCR). PCRs in children treated with both PD and HD were similar, averaging 1.1+/-0.4 g/kg per day (mean+/-SD). Thus, children maintained on PD are at greater risk of protein malnutrition compared with peers treated with HD and adults on PD or HD. A PCR of approximately 1 g/kg per day may not be adequate to maintain nutrition.

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“…Black race and male gender were identified as independent predictors of inadequate hemodialysis. Reports of hemodialysis adequacy in younger children are limited to two small case series with three and ten children less than 12 yr of age, respectively (8,15).…”

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confidence: 99%

Racial and Center Differences in Hemodialysis Adequacy in Children Treated at Pediatric Centers

Leonard

Stablein

et al. 2004

Journal of the American Society of Nephrology

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Abstract. This study assessed hemodialysis adequacy in pediatric centers. Monthly adequacy data were requested in NAPRTCS enrollees on hemodialysis for at least 6 mo. Data forms were returned for 147 children from 32 centers. Data are presented for the 138 children (57% boys, 45% black) that were dialyzed 3 times/wk, representing 2282 patientmonths of follow-up. Pre-and postdialysis BUN levels were reported in all children. Kt/V values were reported in 76 children; however, sufficient data were obtained to calculate Kt/V in 129 children. On average, 14.9 Kt/V and 15.2 urea reduction ratio (URR) values were calculated per child. Aggregate dialysis dose was defined as adequate if Kt/V was Ͼ1.2 in at least 75% of calculated Kt/V measures within a subject. Mean Ϯ SD age was 11.3 Ϯ 3.7 yr (median, 12.0 yr). Hemodialysis dose was variable within subjects (median CV%: URR 8.2, Kt/V 16.9). Aggregate dialysis dose was adequate in 70% of subjects. Multivariate logistic regression showed male gender (OR, 0.41; 95% CI, 0.16 to 0.98), black race (OR, 0.28; 95% CI, 0.11 to 0.67), larger body surface area (fourth versus first quartile: OR, 0.22; 95% CI, 0.05 to 0.80), and absence of reported Kt/V at the treating center (OR, 0.26; 95% CI, 0.10 to 0.62) were significant predictors of inadequate dialysis dose. Age, renal diagnosis, and center size were not associated with adequacy. Racial and gender disparities in hemodialysis dose existed among children at specialized academic pediatric centers and a substantial proportion received inadequate hemodialysis.

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Outcome data on pediatric dialysis patients from the end-stage renal disease Clinical Indicators Project

Cited by 40 publications

References 12 publications

Long-term outcome of chronic dialysis in children

Long-term outcome of chronic dialysis in children

Prevalence of protein malnutrition in children maintained on peritoneal dialysis

Racial and Center Differences in Hemodialysis Adequacy in Children Treated at Pediatric Centers

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