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Stewart NP, Quinlan C, Best S, Mynard JP. Noninvasive pediatric blood pressure assessment: exploring the clinicians' perspective. Blood Press Monit 2024; 29:127-135. [PMID: 38386314 DOI: 10.1097/mbp.0000000000000693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Obtaining accurate and reliable blood pressure (BP) readings in pediatric patients is challenging, given difficulties in adhering to measurement guidelines, limited device validation and variable patient cooperation. This study aimed to investigate clinicians' perspectives surrounding noninvasive pediatric BP assessment to identify opportunities for improvement in BP technology and clinical practice. METHOD Based on an adapted version of the extended Technology Acceptance Model 2, semi-structured interviews were conducted with clinicians involved in noninvasive pediatric BP assessment in a major Australian children's hospital. Transcripts were analyzed thematically and guided by Technology Acceptance Model 2. RESULTS Clinician responses ( n = 20) revealed that poor patient tolerance of BP measurement resulting from excessive cuff inflation is a major hindrance to reliable pediatric BP assessment. Clinicians described low trust in BP readings from automated devices, often relating to poor patient tolerance to cuff inflation, thereby diminishing the clinical utility of these readings in informing treatment decisions. Auscultatory measurement was regarded as more trustworthy and better tolerated, but less convenient to perform as compared with oscillometric measurement. CONCLUSION A dissonance exists between (1) low trust and clinical utility of the most common and easy-to-use BP measurement approach (automated devices), versus (2) higher trust and clinical utility, but efficiency and user-related impediments, for the auscultatory method. Based on our results, we have developed the Blood Pressure Acceptance Model, which can be used to explain and predict clinicians' acceptance of BP technology. Further work is needed to improve the tolerability and accuracy of automated BP devices in real-world pediatric settings.
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Affiliation(s)
- Natalie P Stewart
- Heart Research, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
| | - Catherine Quinlan
- Department of Paediatrics, University of Melbourne
- Department of Nephrology, Royal Children's Hospital
- Kidney Regeneration, Murdoch Children's Research Institute, Parkville VIC
| | - Stephanie Best
- Department of Health Services Research, Peter MacCallum Cancer Centre
- Victorian Comprehensive Cancer Centre, Melbourne, VIC
- Australian Genomics, Murdoch Children's Research Institute, Parkville, VIC
- Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC
| | - Jonathan P Mynard
- Heart Research, Murdoch Children's Research Institute
- Department of Paediatrics, University of Melbourne
- Department of Biomedical Engineering, University of Melbourne, Parkville VIC, Australia
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Crawford B, Kizilbash S, Bhatia VP, Kulsum-Mecci N, Cannon S, Bartosh SM. Native nephrectomy in advanced pediatric kidney disease: indications, timing, and surgical approaches. Pediatr Nephrol 2024; 39:1041-1052. [PMID: 37632524 DOI: 10.1007/s00467-023-06117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/27/2023] [Accepted: 07/27/2023] [Indexed: 08/28/2023]
Abstract
In pediatric kidney failure, native kidneys may pose a risk to successful transplant outcomes. The indications and timing of native nephrectomy represent a controversial management decision. A lack of high-quality, outcomes-based data has prevented development of evidence-based guidelines for intervention. In this article, we review the published literature on medical indications for native nephrectomy and current knowledge gaps. In addition, we provide a surgical perspective regarding timing and approach.
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Affiliation(s)
- Brendan Crawford
- Department of Pediatrics, Division of Nephrology, University of Arkansas Medical Sciences, Little Rock, AR, USA.
| | - Sarah Kizilbash
- Department of Pediatrics, Division of Nephrology, University of Minnesota, Minneapolis, MN, USA
| | - Vinaya P Bhatia
- Department of Urology, Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nazia Kulsum-Mecci
- Department of Pediatrics, Division of Nephrology, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Shannon Cannon
- Department of Urology, Division of Pediatric Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sharon M Bartosh
- Department of Pediatrics, Division of Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Hemodiafiltration maintains a sustained improvement in blood pressure compared to conventional hemodialysis in children-the HDF, heart and height (3H) study. Pediatr Nephrol 2021; 36:2393-2403. [PMID: 33629141 DOI: 10.1007/s00467-021-04930-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/08/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertension is prevalent in children on dialysis and associated with cardiovascular disease. We studied the blood pressure (BP) trends and the evolution of BP over 1 year in children on conventional hemodialysis (HD) vs. hemodiafiltration (HDF). METHODS This is a post hoc analysis of the "3H - HDF-Hearts-Height" dataset, a multicenter, parallel-arm observational study. Seventy-eight children on HD and 55 on HDF who had three 24-h ambulatory BP monitoring (ABPM) measures over 1 year were included. Mean arterial pressure (MAP) was calculated and hypertension defined as 24-h MAP standard deviation score (SDS) ≥95th percentile. RESULTS Poor agreement between pre-dialysis systolic BP-SDS and 24-h MAP was found (mean difference - 0.6; 95% limits of agreement -4.9-3.8). At baseline, 82% on HD and 44% on HDF were hypertensive, with uncontrolled hypertension in 88% vs. 25% respectively; p < 0.001. At 12 months, children on HDF had consistently lower MAP-SDS compared to those on HD (p < 0.001). Over 1-year follow-up, the HD group had mean MAP-SDS increase of +0.98 (95%CI 0.77-1.20; p < 0.0001), whereas the HDF group had a non-significant increase of +0.15 (95%CI -0.10-0.40; p = 0.23). Significant predictors of MAP-SDS were dialysis modality (β = +0.83 [95%CI +0.51 - +1.15] HD vs. HDF, p < 0.0001) and higher inter-dialytic-weight-gain (IDWG)% (β = 0.13 [95%CI 0.06-0.19]; p = 0.0003). CONCLUSIONS Children on HD had a significant and sustained increase in BP over 1 year compared to a stable BP in those on HDF, despite an equivalent dialysis dose. Higher IDWG% was associated with higher 24-h MAP-SDS in both groups.
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Fu Q, Chen Z, Fan J, Ling C, Wang X, Liu X, Shen Y. Lung ultrasound methods for assessing fluid volume change and monitoring dry weight in pediatric hemodialysis patients. Pediatr Nephrol 2021; 36:969-976. [PMID: 33067674 DOI: 10.1007/s00467-020-04735-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The value of lung ultrasound in adult hemodialysis has been confirmed. The determination of dry weight in children remains challenging. This study explores the usefulness of lung ultrasound in assessing fluid volume change and the possibility of pulmonary ultrasound as a method to monitor dry weight in pediatric dialysis patients. METHODS This was a prospective observational study. We compared the predialysis and postdialysis B-line scores of the dry-weight group and non-dry-weight group. Changes in body weight and B-line scores were recorded during the dialytic period and interdialytic period, and the correlation was analyzed. Lung ultrasound was performed after the dialysis session every Friday, and B-line score < 10 was considered to indicate that there was no volume overload; the weight was recorded as the target weight. RESULTS Fourteen patients were included. A total of 78 ultrasound assessments were performed: 30 in the dry-weight group and 48 in the non-dry-weight group. The B-line scores decreased after dialysis in all patients (p < 0.001). Thirty-three assessments were performed in the interdialytic period, and 40 assessments in the dialytic period were performed within 1 week. Linear regression showed that changes in B-line number were directly and positively correlated with interdialytic weight gain (r = 0.517, p = 0.002) and dialytic weight loss (r = 0.558, p < 0.001). The weight of the children increased gradually without volume overload in two patients during follow-up. CONCLUSION Lung ultrasound can assess the fluid volume change of pediatric dialysis patients in real time. Lung ultrasound could be a valuable method for monitoring dry weight in pediatric dialysis patients.
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Affiliation(s)
- Qian Fu
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China
| | - Zhi Chen
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China
| | - Jianfeng Fan
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China
| | - Chen Ling
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China
| | - Xiaoman Wang
- Department of Ultrasound, Beijing Children's Hospital Affiliated to Capital Medical University, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China
| | - Xiaorong Liu
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China.
| | - Ying Shen
- Department of Nephrology, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing Key Laboratory for Chronic Renal Disease and Blood Purification, National Center for Children's Health, West District Nan Li Shi Lu 56th, Beijing, 100045, China.
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Karava V, Benzouid C, Kwon T, Macher MA, Deschênes G, Hogan J. Interdialytic weight gain and vasculopathy in children on hemodialysis: a single center study. Pediatr Nephrol 2018; 33:2329-2336. [PMID: 30178237 DOI: 10.1007/s00467-018-4026-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 06/04/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increased interdialytic weight gain (IDWG) has been associated with poor outcomes in adults, but its impact on hemodialysis vasculopathy in children is unknown. METHODS Nineteen patients (age 9 to 19 years old) with a median hemodialysis duration of 10.4 months were enrolled. Cardiovascular evaluation included left ventricular mass index (LVMI), pulse wave velocity (PWV), and carotid intima-media thickness (cIMT) measurements. PWV and cIMT were expressed as z-scores based on reference values in healthy children. Blood pressure (BP) evaluation consisted in a 24-h ambulatory BP monitoring. Mean IDGW and residual urine output during the 6 months prior to cardiovascular examination were calculated. RESULTS Increased cIMT, LVMI, and PWV was observed in 11 (57.9%), 7 (36.8%), and 5 (26.3%) patients respectively, while BP was normal in all patients. Median IDWG was 3.5% (1.8-6.7). Residual urine output and BP status did not significantly differ between patients with IDWG ≥ or < 4%. After linear regression, IDWG was correlated to cIMT z-score (r2 = 0.485, p = 0.001), but not to PWV z-score (r2 = 0.04, p = 0.415) and LVMI (r2 = 0.092, p = 0.206). After univariate logistic regression, IDWG ≥ 4% was significantly associated to increased cIMT (above 1.65 SDS) (odds ratio 12.25, 95% confidence interval 1.08-138.988). The trend toward an increased cIMT with IDWG ≥ 4% was observed in both patients with short and long dialysis vintage. CONCLUSIONS High IDWG is associated with increased cIMT in hemodialyzed children independently of BP control and dialysis vintage. This observation reinforces the importance of interventions to avoid IDWG in hemodialyzed children.
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Affiliation(s)
- Vasiliki Karava
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France.
| | - Cherine Benzouid
- Pediatric Cardiology Department, Robert Debré Hospital, APHP, Paris, France
| | - Theresa Kwon
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Marie-Alice Macher
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, APHP, Paris, France
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Niel O, Bastard P, Boussard C, Hogan J, Kwon T, Deschênes G. Artificial intelligence outperforms experienced nephrologists to assess dry weight in pediatric patients on chronic hemodialysis. Pediatr Nephrol 2018; 33:1799-1803. [PMID: 29987454 DOI: 10.1007/s00467-018-4015-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dry weight is the lowest weight patients on hemodialysis can tolerate; correct dry weight estimation is necessary to minimize morbi-mortality, but is difficult to achieve. Here, we used artificial intelligence to improve the accuracy of dry weight assessment in hemodialysis patients. METHODS/RESULTS We designed a neural network which used bio-impedancemetry, blood volume monitoring, and blood pressure values as inputs; output was artificial intelligence dry weight. Fourteen pediatric patients were switched from nephrologist to artificial intelligence dry weight. Artificial intelligence dry weight was higher (28.6%), lower (50%), or identical to nephrologist dry weight. Mean difference between artificial intelligence and nephrologist dry weights was 0.497 kg (- 1.33 to + 1.29 kg). In patients for whom artificial intelligence dry weight was lower than nephrologist dry weight, systolic blood pressure significantly decreased after dry weight decrease to artificial intelligence dry weight (77th to 60th percentile, p = 0.022); anti-hypertensive treatments were successfully decreased or discontinued in 28.7% of cases. In patients for whom artificial intelligence dry weight was higher than nephrologist dry weight, no hypertension was observed after dry weight increase to artificial intelligence dry weight; when present, symptoms of dry weight underestimation receded. CONCLUSIONS Neural network predictions outperformed those of experienced nephrologists in most cases, proving artificial intelligence is a powerful tool for predicting dry weight in hemodialysis patients.
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Affiliation(s)
- Olivier Niel
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Paul Bastard
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Charlotte Boussard
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thérésa Kwon
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
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Paglialonga F, Consolo S, Edefonti A, Montini G. The first hour refill index: a promising marker of volume overload in children and young adults on chronic hemodialysis. Pediatr Nephrol 2018; 33:1209-1214. [PMID: 29492673 DOI: 10.1007/s00467-018-3915-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Volume overload is a known risk factor for cardiovascular complications in children on hemodialysis (HD), but a measurable index of volume overload is still lacking. METHODS We propose a novel index of pre-HD volume overload based on blood volume (BV) monitoring, the first hour refill index (RI), calculated as the ratio between the ultrafiltration rate indexed for body weight during the first HD hour and the percent BV change at the first hour of the treatment. This parameter was retrospectively calculated in 121 sessions in 11 oligoanuric children and young adults on chronic HD, with median age 14.3 years (range 5.4-22.4), and its association with left-ventricular mass index, pre-HD blood pressure, and number of antihypertensive medications was evaluated. RESULTS The median RI was 2.07 ml/kg/h/%. There was a significant correlation between RI and median LVMI (r 0.66, p = 0.028), which was 53.4 g/m2.7 (45.7-64) in patients with a median RI > 2, and 36.6 g/m2.7 (24.9-47) in those with a median RI < 2 ml/kg/h/% (p = 0.01). The number of antihypertensive drugs per patient was significantly higher in patients with a RI > 2 than in those with a RI < 2 ml/kg/h/% (three vs one per patient; p = 0.02) while blood pressure was not significantly different between the two groups. CONCLUSIONS The ratio between the ultrafiltration rate per body weight and the BV change during the first hour of a HD session could be a promising index of refill capacity and pre-HD volume overload in children and young adults on chronic HD.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
| | - Silvia Consolo
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Alberto Edefonti
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Ambulatory Blood Pressure Monitoring in Children and Adolescents: a Review of Recent Literature and New Guidelines. Curr Hypertens Rep 2017; 19:96. [DOI: 10.1007/s11906-017-0791-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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