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Abstract
Various modalities of high-intensity hemodialysis are gathering increasing popularity. Some of the advantages of these new dialysis regimens are presented. Time and the increasing use of these novel approaches will ultimately determine their role in the overall management of patients with end-stage renal disease.
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Affiliation(s)
- T. S. Ing
- Department of Medicine, Hines VA/Loyola University Medical Center, Hines, Illinois - USA
| | - C. Ronco
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. R. Blagg
- Northwest Kidney Centers and University of Washington, Seattle, Washington - USA
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2
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Cost analysis of substitutive renal therapies in children. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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3
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Camargo MFCD, Barbosa KDS, Fetter SK, Bastos A, Feltran LDS, Koch-Nogueira PC. Cost analysis of substitutive renal therapies in children. J Pediatr (Rio J) 2018; 94:93-99. [PMID: 28750890 DOI: 10.1016/j.jped.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 04/19/2017] [Accepted: 02/27/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE End-stage renal disease is a health problem that consumes public and private resources. This study aimed to identify the cost of hemodialysis (either daily or conventional hemodialysis) and transplantation in children and adolescents. METHODS This was a retrospective cohort of pediatric patients with End-stage renal disease who underwent hemodialysis followed by kidney transplant. All costs incurred in the treatment were collected and the monthly total cost was calculated per patient and for each renal therapy. Subsequently, a dynamic panel data model was estimated. RESULTS The study included 30 children who underwent hemodialysis (16 conventional/14 daily hemodialysis) followed by renal transplantation. The mean monthly outlay for hemodialysis was USD 3500 and USD 1900 for transplant. Hemodialysis costs added up to over USD 87,000 in 40 months for conventional dialysis patients and USD 131,000 in 50 months for daily dialysis patients. In turn, transplant costs in 50 months reached USD 48,000 and USD 70,000, for conventional and daily dialysis patients, respectively. For conventional dialysis patients, transplant is less costly when therapy exceeds 16 months, whereas for daily dialysis patients, the threshold is around 13 months. CONCLUSION Transplantation is less expensive than dialysis in children, and the estimated thresholds indicate that renal transplant should be the preferred treatment for pediatric patients.
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Affiliation(s)
| | | | | | - Ana Bastos
- Hospital Samaritano, São Paulo, SP, Brazil
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Laskin BL, Huang G, King E, Geary DF, Licht C, Metlay JP, Furth SL, Kimball T, Mitsnefes M. Short, frequent, 5-days-per-week, in-center hemodialysis versus 3-days-per week treatment: a randomized crossover pilot trial through the Midwest Pediatric Nephrology Consortium. Pediatr Nephrol 2017; 32:1423-1432. [PMID: 28389745 PMCID: PMC5485844 DOI: 10.1007/s00467-017-3656-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND No controlled trials in children with end-stage kidney disease have assessed the benefits of more frequently administered hemodialysis (HD). METHODS We conducted a multicenter, crossover pilot trial to determine if short, more frequent (5 days per week) in-center HD was feasible and associated with improvements in blood pressure compared with three conventional HD treatments per week. Because adult studies have not controlled for the weekly duration of dialysis, we fixed the total treatment time at 12 h a week of dialysis during two 3-month study periods; only frequency varied from 5 to 3 days per week between study periods. RESULTS Eight children (median age 16.7 years) consented at three children's hospitals. The prespecified primary composite outcome was a sustained 10% decrease in systolic blood pressure and/or a decrease in antihypertensive medications relative to each study period's baseline. Among the six patients completing both study periods, five (83.3%) experienced the primary outcome during HD performed 5 days per week but not 3 days per week; one of the six (16.7%) achieved that outcome during 3-day but not 5-day (p = 0.22) per week HD. During 5-day HD, all patients had significantly more treatments during which their pre-HD systolic (p = 0.01) or diastolic (p = 0.01) blood pressure was 10% lower than baseline. CONCLUSIONS We observed that more frequent HD sessions per week was feasible and associated with improved blood pressure control, but barriers to changing thrice-weekly standard of care include financial reimbursement and the time demands associated with more frequent treatments.
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Affiliation(s)
- Benjamin L. Laskin
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Guixia Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Eileen King
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Christoph Licht
- Division of Nephrology, The Hospital for Sick Children, Toronto, Canada
| | - Joshua P. Metlay
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Susan L. Furth
- Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA,Department of Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Tom Kimball
- Division of Cardiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Mark Mitsnefes
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Tjaden LA, Grootenhuis MA, Noordzij M, Groothoff JW. Health-related quality of life in patients with pediatric onset of end-stage renal disease: state of the art and recommendations for clinical practice. Pediatr Nephrol 2016; 31:1579-91. [PMID: 26310616 PMCID: PMC4995226 DOI: 10.1007/s00467-015-3186-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/21/2015] [Accepted: 07/27/2015] [Indexed: 11/14/2022]
Abstract
Health-related quality of life (HRQoL) is increasingly recognized as a key outcome in both clinical and research settings in the pediatric population with end-stage renal disease (ESRD). This review aims to: (1) summarize the current knowledge on HRQoL and socioprofessional outcomes and (2) provide strategies for incorporation of HRQoL assessment into clinical practice. Studies report that pediatric patients with ESRD have significantly lower HRQoL scores compared with children with other chronic diseases. Patients treated by dialysis are at particularly high risk for impaired HRQoL. Furthermore, patients more often have impaired neurocognitive functioning and lower academic achievement. Important determinants of impaired HRQoL include medical factors (i.e., receiving dialysis, disabling comorbidities, cosmetic side effects, stunted growth), sociodemographic factors (i.e., female gender, non-Western background) and psychosocial factors (i.e., noneffective coping strategies). Contrary to the situation in childhood, adult survivors of pediatric ESRD report a normal mental HRQoL. Despite this subjective feeling of well-being, these patients have on average experienced significantly more difficulties in completing their education, developing intimate relationships, and securing employment. Several medical and psychosocial strategies may potentially improve HRQoL in children with ESRD. Regular assessment of HRQoL and neurocognitive functioning in order to identify areas in which therapies and interventions may be required should be part of standard clinical care.
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Affiliation(s)
- Lidwien A Tjaden
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Martha A Grootenhuis
- Psychosocial Department, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies Noordzij
- Department of Medical Informatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Jaap W Groothoff
- Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.
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Paglialonga F, Consolo S, Galli MA, Testa S, Edefonti A. Interdialytic weight gain in oligoanuric children and adolescents on chronic hemodialysis. Pediatr Nephrol 2015; 30:999-1005. [PMID: 25395362 DOI: 10.1007/s00467-014-3005-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/24/2014] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Little is known about the clinical impact of interdialytic weight gain (IDWG) on oligoanuric children undergoing chronic hemodialysis (HD). METHODS We retrospectively assessed IDWG, left ventricular mass index (LVMI) and its changes (ΔLVMI), pre-HD systolic and diastolic blood pressure (DBP), residual urine output, Kt/V, the frequency of intradialytic symptoms, normalized protein catabolic rate, and the 3-month change in the dry weight of 16 hemodialyzed oligoanuric patients with a median age of 14.8 years (range 5.0-17.9). RESULTS There was a significant correlation between IDWG and median LVMI (r 0.55, p = 0.026), which was 27.3 g/m(2.7) (22.5-37.6) in the patients with a median IDWG of <4 %, and 44.3 g/m(2.7) (28.2-68.7) in those with a median IDWG of >4 % (p = 0.003). None of the four patients with an IDWG of <4 % showed left ventricular hypertrophy, compared with 10 of the 12 patients (83.3 %) with an IDWG of >4 % (p = 0.003); the former also had a better median ΔLVMI (-33.5 % vs -13.0 %; p = 0.02) and a lower median DBP sds (0.24 vs 1.72, p = 0.04). CONCLUSIONS There is a significant correlation between IDWG and LVMI in pediatric oligoanuric patients on chronic HD: those with an IDWG of >4 % are at a higher risk of left ventricular hypertrophy.
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Affiliation(s)
- Fabio Paglialonga
- Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy,
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Fischbach M, Zaloszyc A, Laetitia H, Menouer S, Terzic J. Why does three times per week hemodialysis provide inadequate dialysis for children? Hemodial Int 2014; 18 Suppl 1:S39-42. [DOI: 10.1111/hdi.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Michel Fischbach
- Nephrology Dialysis Transplantation Children's Unit; University Hospital Hautepierre; Strasbourg France
| | - Ariane Zaloszyc
- Nephrology Dialysis Transplantation Children's Unit; University Hospital Hautepierre; Strasbourg France
| | - Higel Laetitia
- Nephrology Dialysis Transplantation Children's Unit; University Hospital Hautepierre; Strasbourg France
| | - Soraya Menouer
- Nephrology Dialysis Transplantation Children's Unit; University Hospital Hautepierre; Strasbourg France
| | - Joelle Terzic
- Nephrology Dialysis Transplantation Children's Unit; University Hospital Hautepierre; Strasbourg France
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Warady BA, Neu AM, Schaefer F. Optimal Care of the Infant, Child, and Adolescent on Dialysis: 2014 Update. Am J Kidney Dis 2014; 64:128-42. [DOI: 10.1053/j.ajkd.2014.01.430] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/28/2014] [Indexed: 12/18/2022]
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de Camargo MFC, Henriques CL, Vieira S, Komi S, Leão ER, Nogueira PCK. Growth of children with end-stage renal disease undergoing daily hemodialysis. Pediatr Nephrol 2014; 29:439-44. [PMID: 24253592 DOI: 10.1007/s00467-013-2676-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this report is to describe the effect of daily hemodialysis on the growth of children with end-stage renal disease (ESRD). METHODS We performed a prospective, observational study on 24 children with ESRD undergoing daily hemodialysis (DHD). The control group comprised 26 children on concurrent conventional hemodialysis (CHD), and the follow-up for both groups was 9.3 ± 3.0 months. No patient received growth hormone (GH) therapy. RESULTS At the onset of the study, the height-for-age Z-score was -2.12 ± 1.54 in the CHD group and -2.84 ± 2.27 in the DHD group (p = 0.313). Assuming an increase of 0.5 standard deviation scores (SDS) of the height-for-age parameter as an improvement of growth, there were 33 % of patients in the DHD group and 8 % in the CHD group (p = 0.035). The cumulative probability of gain in height for age at 12 months was 40 % in the DHD group versus 15 % in the CHD group (p = 0.047). Also, 98 % of patients in the DHD group had an adequate total caloric intake, whereas 38 % in the CHD group reached this goal (p < 0.001). No patient left the study due to intensification of the dialysis modality. CONCLUSIONS Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.
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Tong A, Henning P, Wong G, McTaggart S, Mackie F, Carroll RP, Craig JC. Experiences and Perspectives of Adolescents and Young Adults With Advanced CKD. Am J Kidney Dis 2013; 61:375-84. [DOI: 10.1053/j.ajkd.2012.09.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 09/24/2012] [Indexed: 11/11/2022]
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Curran SP, Chan CT. Intensive hemodialysis: normalizing the "unphysiology" of conventional hemodialysis? Semin Dial 2011; 24:607-13. [PMID: 22122548 DOI: 10.1111/j.1525-139x.2011.01010.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in intensified hemodialysis (HD) regimens is increasing internationally, as there is growing evidence that they are associated with improved outcomes. Appreciation that conventional hemodialysis (CHD), delivered as 4-hour sessions three times a week, is not providing optimal physiological replacement of renal function has led to the development of intensified dialysis therapies. These include long intermittent hemodialysis typically lasting 6-8 hours and delivered three times a week, short daily hemodialysis, providing more frequent sessions 4-7 days a week lasting 2-3.5 hours, and nocturnal hemodialysis, performed 5-7 days a week for 6-8 hours. Studies evaluating outcomes from these programs have indicated superior results to those achieved with CHD, including favorable modifications of cardiovascular risk factors and improvements in a variety of clinical measures. The objective of this review is to present available evidence supporting the hypothesis that in an attempt to provide a "more normal physiology," intensified HD regimens achieve outcomes superior to those historically achieved with CHD.
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Affiliation(s)
- Simon P Curran
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Fischbach M, Fothergill H, Zaloszyc A, Menouer S, Terzic J. Intensified Daily Dialysis: The Best Chronic Dialysis Option for Children? Semin Dial 2011; 24:640-4. [DOI: 10.1111/j.1525-139x.2011.01020.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Sebestyen JF, Warady BA. Advances in pediatric renal replacement therapy. Adv Chronic Kidney Dis 2011; 18:376-83. [PMID: 21896380 DOI: 10.1053/j.ackd.2011.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/11/2022]
Abstract
Advances in the understanding and clinical application of hemodialysis, peritoneal dialysis, and continuous renal replacement therapy have resulted in strategies designed to further improve their safety and efficacy. These advances have been particularly important to children, in whom a variety of clinical and technical issues must be taken into consideration for optimum dialysis across a broad spectrum of patient size and need. This manuscript reviews recent data pertaining to the use of renal replacement therapy, with an emphasis on those aspects of dialysis management that are especially pertinent to pediatric ESRD and acute kidney injury care.
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Uncontrolled hypertension in children on hemodialysis. Nat Rev Nephrol 2010; 6:7-8. [DOI: 10.1038/nrneph.2009.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A. Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 2009; 25:867-73. [DOI: 10.1093/ndt/gfp565] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Fischbach M, Dheu C, Seuge L, Orfanos N. Hemodialysis and Nutritional Status in Children: Malnutrition and Cachexia. J Ren Nutr 2009; 19:91-4. [DOI: 10.1053/j.jrn.2008.10.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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