Principles of Renal Replacement Therapy in Children

Management of end-stage renal failure

“…In developed countries, well-functioning renal transplantation continues to result in the best quality of life for patients with ESRF, and therefore dialysis is used most often as a bridge to allow for the care of ESRF patients until such time that they can be transplanted [10][11][12]. However, all forms of RRT are associated with certain problems, complications and even deaths.…”

“…Continuous ambulatory peritoneal dialysis, a common form of therapy in ESRF, is complicated by severe infections, such as peritonitis and exit-site and tunnel infections, which may result in peritoneal thickening and technique failure. An overall mortality rate of 5.7% was reported in a pediatric peritoneal dialysis population [14][15][16]. Hemodialysis requires the creation of a permanent vascular access, which may fail because of repeated needle punctures.…”

“…Hemodialysis requires the creation of a permanent vascular access, which may fail because of repeated needle punctures. The need for heparinization to prevent clotting in the extracorporeal circuit is an additional concern [13][14][15][16][17][18]. Lifelong immunosuppression is required for the functional life of the graft; with infection and malignancy being the most feared risks [19].…”

Relation Between Pediatric Experience and Treatment Recommendations for Children and Adolescents With Kidney Failure

“…[24][25][26] Our study demonstrates that when caring for patients with identical clinical and social characteristics, nephrologists with greater pediatric experience are significantly more likely than their adulttrained counterparts to recommend PD, a therapy that is more cost-effective and has demonstrated clinical benefits for children. 16,17,20 The association between pediatric experience and the recommendation for PD persisted when pediatric experience was measured by pediatric subspecialization, experience with treating children, or as increased exposure to pediatric patients during nephrology fellowship. Additionally, the association of pediatric experience and recommendations for PD persisted regardless of geographic region, practice setting, years in practice, or dialysis training.…”

“…15 Although no prospective, randomized trials comparing PD and HD have been performed, PD has multiple advantages for children. 16 These include steady state fluid and biochemical control, freedom from dietary and fluid restrictions, relative technical ease in infants and small children, absence of needle sticks, independence and relative normalization of daily routine because PD is a home modality, decreased dependence on antihypertensive medications to control blood pressure, and less anemia than with HD. Additionally, costs are lower with PD than with HD in children.…”