The ethics of withholding and withdrawing dialysis therapy in infants

Shooter, Michael; Watson, Alan R.

doi:10.1007/s004670050773

Cited by 43 publications

(25 citation statements)

References 15 publications

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“…Twenty-nine received a diagnosis antenatally. Median follow-up was 13 The majority (41 of 51) of the patients had more than one comorbidity. a Only one nonrenal comorbidity.…”

Section: Resultsmentioning

confidence: 99%

Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Mekahli

Shaw

Ledermann

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives: In 2000, we reported the outcome of 101 children with a GFR <20 ml/min per 1.73 m 2 at 0.3 yr of age (range 0.0 to 1.5 yr). Long-term data on such young children are scarce.Design, setting, participants, & measurements: Mortality, treatment modalities, and growth were reanalyzed 9.9 yr later. Results: Of the 101 patients, 28 died and three were lost to follow-up during 13.90 yr (range 0.03 to 22.90 yr). One-, 2-, 5-, 10-, 15-, 20-, and 22-yr survivals were 87, 81, 77, 75, 73, 72, and 64%, respectively. Fifty-one children had comorbidities. Sixty-six percent were tube fed for 1.7 yr (range 0.1 to 6.9 yr), 37% had a gastrostomy, and 13% had a Nissen fundoplication. Mean height SD score (SD) was ؊0.42 (2.33) at birth (n ‫؍‬ 40), ؊2.07 (1.34) at 0.5 (n ‫؍‬ 62), ؊1.93 (1.38) at 1 (n ‫؍‬ 72), ؊1.14 (1.14) at 5 (n ‫؍‬ 67), ؊1.04 (1.15) at 10 (n ‫؍‬ 62), ؊1.84 (1.32) at 15 (n ‫؍‬ 40), and ؊1.68 (1.52) at age >18 yr (n ‫؍‬ 32). Comorbidities adversely influenced growth (P < 0.01) and final height (P ‫؍‬ 0.02): Mean height SD score (SD) was ؊1.16 (1.38) in otherwise normal adults.Conclusions: Growth and final height in infants with severe chronic kidney disease are influenced by comorbidity. Intensive feeding and early transplantation resulted in a mean adult height within the normal range in patients without comorbidities. Overall mortality is comparable to that of older children.Clin J Am Soc Nephrol

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“…Twenty-nine received a diagnosis antenatally. Median follow-up was 13 The majority (41 of 51) of the patients had more than one comorbidity. a Only one nonrenal comorbidity.…”

Section: Resultsmentioning

confidence: 99%

Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Mekahli

Shaw

Ledermann

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Chronic peritoneal dialysis at home is being developed with increasing nursing expertise but still with many restrictions due to socio-economic factors. Good communication with families and within the multiprofessional team are essential to resolve many of the logistical and ethical issues posed by the current restrictions on provision of care, not only in Sudan but in many parts of the world [29,30].…”

Section: Discussionmentioning

confidence: 99%

Chronic renal failure in Sudanese children: aetiology and outcomes

Ali¹,

Abdelraheem²,

Mohamed³

et al. 2009

Pediatr Nephrol

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The provision of tertiary paediatric nephrology facilities has led to increasing referrals of children with chronic renal failure (CRF). We report the aetiology and outcomes over 5 years, during which period the improving socio-economic situation has allowed increasing provision of dialysis and transplantation. The records of 205 children (124 male; 60.5%) who were referred to a tertiary paediatric nephrology unit in Khartoum between 2001 and 2006 with a glomerular filtration rate of less than 50 ml/min per 1.73 m(2) body surface area were reviewed. The mean age at the time of diagnosis with CRF was 9.8 years (range 3 months-17 years). The aetiology was chronic glomerulonephritis in 52 (25.4%), congenital urological malformations in 36 (17.5%), urolithiasis in 19 (9.3%), hereditary nephropathy in 14 (6.8%), multisystem diseases in 4 (2%), and cause unknown in 80 (39.1%). Of the 205 children, 136 (63%) had reached end-stage renal failure, with chronic haemodialysis being undertaken in 48 (35.3%), intermittent peritoneal dialysis in 43 (31.6%), continuous ambulatory peritoneal dialysis in 17 (14.7%), and no treatment in 25 (18.4%). At the end of the study period 53 of the 205 (25.9%) remained on dialysis, 51 (25%) were on conservative treatment, 8 (3.9%) had received transplants, 48 (23.4%) had died, and 45 (22%) had been lost to follow-up. The results illustrate the geographical variations in CRF aetiology in different countries, which may be influenced by current patterns of referral as well as environmental and society factors. The large number with an unknown aetiology for their CRF requires further prospective investigation. We hope the current high mortality rate will improve with earlier referral, improved nutrition, family support, and better access to treatment modalities, especially the provision of kidney transplantation from living related donors.

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“…In an international survey of pediatric nephrologists in 1998, 93% indicated that they offered treatment to some infants <1 month of age, while only 41% offered treatment to all infants [7]. In addition, there remain ethical debates in the medical literature regarding the appropriateness of withholding or withdrawing dialysis therapy in infants [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease

et al. 2009

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This study evaluates the long-term outcomes of infants with end stage renal disease (ESRD) who required initiation of chronic peritoneal dialysis (PD) prior to 28 days of age. Infants with ESRD present both ethical and technical challenges for pediatric nephrologists and neonatologists. Recent advances in the medical management of ESRD in infants combined with improved infant transplantation outcomes make it more likely that such infants can survive to successful kidney transplantation. We reviewed all infants initiating PD for ESRD before 28 days of age at the University of Minnesota Amplatz Children's Hospital from 1995 to 2004 (n = 23). Overall 1 - and 5-year patient survival was 52 and 48%, respectively. Twelve children received kidney transplants at a median age and weight of 1.12 years and 9.5 kg, respectively, with a 5-year graft survival rate of 83%. In summary, a majority of infants requiring renal replacement therapy with PD in the first month of life achieve long-term survival with a successful kidney transplant.

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The ethics of withholding and withdrawing dialysis therapy in infants

Cited by 43 publications

References 15 publications

Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Chronic renal failure in Sudanese children: aetiology and outcomes

Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease

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