1
|
Kamath N, Lobo S, Joseph S, Iyengar A. Structured training initiative (STI) for caregivers of children on peritoneal dialysis: a prospective study of the impact on the rate of peritonitis. Pediatr Nephrol 2024; 39:3301-3307. [PMID: 39023537 DOI: 10.1007/s00467-024-06455-w] [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: 04/02/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND Training caregivers performing PD is an important measure to prevent peritonitis. A low literacy rate hinders training in low-resource settings. We designed a structured training initiative (STI) and objective structured assessment (OSA) using visual and kinesthetic resources with minimal use of written resources. We studied the impact of STIs on caregivers' knowledge and practical skills and the rate of peritonitis. METHODS This prospective study conducted initial STI (iSTI) for caregivers of children initiating PD and retraining STI (rSTI) for those already on PD. OSA was administered after completion of training, and those scoring < 95% were retrained. Re-assessment was done at 3, 6, and 12 months, and those who scored < 95% underwent re-training. The rate of PD peritonitis and the time to first peritonitis were compared between the STI group and the cohort on PD in our center who received standard training before STI (controls). RESULTS Caregivers of 40 children were included. The median duration of iSTI and rSTI was 19.5 (18, 20) and 9 (9, 9.5) hrs, and the OSA scores were 97% (97%, 98%) and 96% (96%, 98%), respectively. Only 5% required retraining. There was a significant reduction in the rate of PD peritonitis (0.29 vs. 0.69 episodes/patient-year; p < 0.001) and longer time to peritonitis (189 vs. 69 days; p < 0.001) in the STI group when compared to the controls (n = 32). CONCLUSIONS STI was effective in training caregivers for peritoneal dialysis. There was a reduction in the rate of peritonitis and a longer time to first peritonitis in the STI cohort.
Collapse
Affiliation(s)
- Nivedita Kamath
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India.
| | - Shaila Lobo
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| | - Smitha Joseph
- Department of Biostatistics, St John's Medical College, Bangalore, India
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College Hospital, Bangalore, India
| |
Collapse
|
2
|
Munshi R, Swartz SJ. Incremental dialysis: review of the literature with pediatric perspective. Pediatr Nephrol 2024; 39:49-55. [PMID: 37306719 DOI: 10.1007/s00467-023-06030-9] [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: 01/03/2023] [Revised: 04/24/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
Drivers towards initiation of kidney replacement therapy in advanced chronic kidney disease include metabolic and fluid derangements, growth, and nutritional status with focus on health optimization. Once initiated, prescription of dialysis is often uniform despite variability in patient characteristics and etiology of kidney failure. Preservation of residual kidney function has been associated with improved outcomes in patients with advanced chronic kidney disease on dialysis. Incremental dialysis is the approach of reducing the dialysis dose by reduction in treatment time, days, or efficiency of clearance. Incremental dialysis has been described in adults at initiation of kidney replacement therapy, to better preserve residual kidney function and meet the individual needs of the patient. Consideration of incremental dialysis in pediatrics may be reasonable in a subset of children with continued emphasis on promotion of growth and development.
Collapse
Affiliation(s)
- Raj Munshi
- Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children's, University of Washington, Seattle, WA, USA.
| | - Sarah J Swartz
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
3
|
Marcou M, Galiano M, Tzschoppe A, Sauerstein K, Wach S, Taubert H, Wullich B, Hirsch-Koch K, Apel H. Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference. J Clin Med 2023; 12:7014. [PMID: 38002629 PMCID: PMC10672108 DOI: 10.3390/jcm12227014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival. Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at 5, 10, 15 and 20 years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1 m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1 m2, pretransplantation duration of the recipient on dialysis ≥18 months, hemodialysis prior to transplantation and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival.
Collapse
Affiliation(s)
- Marios Marcou
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Matthias Galiano
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anja Tzschoppe
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Katja Sauerstein
- Clinic of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (M.G.); (A.T.); (K.S.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Sven Wach
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Helge Taubert
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Bernd Wullich
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Karin Hirsch-Koch
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Hendrik Apel
- Clinic of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.W.); (H.T.); (B.W.); (K.H.-K.); (H.A.)
- Transplant Centre Erlangen-Nürnberg, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| |
Collapse
|
4
|
Practice patterns and outcomes of maintenance dialysis in children < 2 years of age: a report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Pediatr Nephrol 2022; 37:1117-1124. [PMID: 34648058 DOI: 10.1007/s00467-021-05287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/19/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred mode of kidney replacement therapy (KRT) in infants and young children with kidney failure. Hemodialysis (HD) is used less often due to the technical challenges and risk of complications in smaller patients. There are limited data on chronic HD in this patient population. METHODS This was a retrospective study of children younger than 24 months on HD and PD in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) registry between January 1992 and December 2018. We compared demographic, clinical, and laboratory data and outcomes, including patient survival and kidney transplantation. RESULTS We identified 1125 infants and toddlers younger than 2 years of age who initiated KRT from January 1992 to December 2018. Of those, 1011 (89.8%) initiated peritoneal dialysis and 114 (10.2%) initiated hemodialysis. Median (IQR) age at HD onset was 12 (5.6-18.7) months compared to 4.6 (0.8-11.7) months at PD onset (p < 0.001). The primary cause of kidney failure with replacement therapy was congenital anomalies of the kidney and urinary tract (56.2% of PD versus 39.5% of HD group). Patients on HD had superior growth and nutrition markers than those on PD. Patient survival was similar between the two groups. CONCLUSIONS While HD may not be the modality of choice for chronic KRT in younger children, 10% of children younger than 24 months of age receive maintenance HD and the numbers have increased over time. Patient survival on dialysis is similar irrespective of dialysis modality. A higher resolution version of the Graphical abstract is available as Supplementary information.
Collapse
|
5
|
Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
Collapse
|
6
|
The Effect of the Hydroalcoholic Extract of Watercress on the Levels of Protein Carbonyl, Inflammatory Markers, and Vitamin E in Chronic Hemodialysis Patients. Biochem Res Int 2021; 2021:5588464. [PMID: 34136285 PMCID: PMC8175173 DOI: 10.1155/2021/5588464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/20/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Chronic kidney disorder is a main public health concern. Inflammatory processes and oxidative stress are common in end-stage renal disease patients. We aimed to evaluate the effect of the hydroalcoholic extract of watercress (WC) on the inflammatory cytokines and protein carbonyl (PCO) contents in chronic hemodialysis patients. Methods This was a double-blind randomized clinical trial performed on 46 hemodialysis patients. The participants were randomly divided into two groups: intervention group (500 mg hydroalcoholic extract of WC every day for 4 weeks) and control group (500 mg of white flour every night for 4 weeks). The blood samples were taken to determine the levels of vitamin E, PCO, and inflammatory cytokines at baseline and the end of treatment. Results Forty-five patients completed the study (22 patients in the intervention group and 23 patients in the control group). There was a significant reduction in the PCO level (20.33 ± 4.40 vs. 15.06 ± 6.41, P=0.001) in the intervention group; also, this change was statistically significant relative to the control group. Furthermore, there were significant reductions in hs-CRP (8953.30 ± 5588.06 vs. 7249.86 ± 5091.62, P=0.007) and IL-6 (60.10 (55.99, 73.10) vs. 55.21 (53.39, 60.48), P=0.050) in the intervention group, but these changes were not significant in comparison with the control group. Conclusion We conclude that the hydroalcoholic extract of WC reduced the PCO content in hemodialysis patients via inhibition of protein oxidation. Although WC administration had caused a significant reduction in IL-6 and CRP levels, these differences were not statistically significant relative to the control group. Further research is needed to identify the antioxidant and anti-inflammatory effects of WC in hemodialysis patients.
Collapse
|
7
|
McCarthy F, Cochat P, Alhasan K, Bonilla-Felix M. Living well with kidney disease. Pediatr Nephrol 2021; 36:1035-1036. [PMID: 33646396 DOI: 10.1007/s00467-021-05011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Florencio McCarthy
- Hospital del Niño Dr. José Renán Esquivel, Calle 34 Este, Panamá City, Panama.
| | - Pierre Cochat
- Centre de référence des maladies rénales rares Néphrogones, Hospices Civils de Lyon & Université Claude-Bernard Lyon 1, Lyon, France
| | - Khalid Alhasan
- Pediatrics Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, PO Box 365067, San Juan, 00936-5067, Puerto Rico
| |
Collapse
|
8
|
Pınarbaşı AS, Dursun I, Günay N, Baatar B, Yel S, Dursun J, Balaban AG, Poyrazoğlu MH, Düşünsel R. Erythropoietin Resistance Index and the Affecting Factors in Children with Peritoneal Dialysis. Blood Purif 2021; 50:942-951. [PMID: 33784664 DOI: 10.1159/000514060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Erythropoiesis-stimulating agents (ESAs) are used to treat anemia in CKD. Erythropoietin resistance index (ERI) is a useful tool used to evaluate the response to ESAs. In this study, we aimed to evaluate the causes of high ERI in children undergoing peritoneal dialysis (PD). METHOD Patients who had been on PD for at least 1 year were included in this retrospective study. Demographic characteristics, residual kidney function (RKF), adequacy of dialysis, peritoneal glucose exposure, the number and reason for hospitalization, and medications were recorded. Anemia and laboratory parameters that may affect anemia were noted by taking the average of laboratory values in the last follow-up year (time-averaged). The weekly ESA dose was proportioned to the annual average hemoglobin value and body weight to calculate the ERI in terms of U/kg/week/g/dL. RESULTS A total of 100 patients were included in the study. The mean ESA dose and ERI value were 119.8 ± 66.22 U/kg/week and 13.01 ± 7.52 U/kg/week/g/dL, respectively. It was determined that the patients <5 years of age have very high ERI value, and these patients need 2 times more ESA than those >10 years of age. Absence of RKF, large number of hospitalization, and ACEI use were also found to affect the ERI value negatively. CONCLUSION We demonstrate that the most important factor affecting ERI value is young age. We also reveal that absence of RKF, large number of hospitalization, and ACEI use are also important variables affecting the ERI value.
Collapse
Affiliation(s)
| | - Ismail Dursun
- Division of Pediatric Nephrology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Neslihan Günay
- Division of Pediatric Nephrology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Batsaikhan Baatar
- Medical Student, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Sibel Yel
- Division of Pediatric Nephrology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Jale Dursun
- Peritoneal Dialysis Nurse, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Aynur Gencer Balaban
- Division of Pediatric Nephrology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Muammer Hakan Poyrazoğlu
- Division of Pediatric Nephrology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ruhan Düşünsel
- Division of Pediatric Nephrology, Department of Pediatrics, Yeditepe Unıversity Faculty of Medicine, İstanbul, Turkey
| |
Collapse
|
9
|
Zhai Y, Liu X, Yang Q, Dang X, Sun S, Shao X, Liu X, Wu Y, Bai H, Mao J, Dong Y, Ma Q, Kang G, Huang W, Zhu H, Fu R, Zhang A, Xu R, Sun Q, Jiang X, Lai L, Huang J, Luan J, Xia Z, Cui J, Zhao M, Wu X, Zhang Q, Li Y, Liu C, Wang M, Wang F, Tao Y, Huang Z, Zhang D, Zhao B, Chen C, Huang C, Gao X, Shen Q, Shen Y, Xu H. IPDN-China promotes the development of pediatric dialysis in China. Pediatr Nephrol 2020; 35:2163-2171. [PMID: 32529322 DOI: 10.1007/s00467-020-04630-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In mainland China, dialysis for children with end-stage renal disease (ESRD) was not introduced until the 1980s. To describe the development of pediatric dialysis in different regions of China, a national pediatric dialysis network, namely, International Pediatric Dialysis Network-China (IPDN-China) ( www.pedpd.org.cn ), was launched in 2012. METHODS Original and updated information from the renal centers registered with the IPDN-China was collected between 2012 and 2016 from two sources, namely, the registry and the survey, and demographic features were analyzed. RESULTS Due to promotion by the IPDN-China, the number of registered renal centers increased from 12 to 39 between 2012 and 2016, with a significant increase in the coverage of the Chinese administrative divisions (from 26.5 to 67.6%) (p < 0.01); and the coverage of the pediatric (0~14 years old) population increased to nearly 90% in 2016. The distribution of renal centers indicated that East China had the highest average number of registered centers per million population (pmp) 0~14-year-old age group. Seventeen relatively large dialysis centers were distributed across 14 divisions. Various modalities of renal replacement therapy (RRT) were available in most centers. The IPDN-China has promoted collaborations between dieticians, psychologists, and social workers on dialysis teams to provide better service to children with ESRD and their families. The proportion of centers with all three types of paramedic support (i.e., dieticians, psychologists, and social workers) as well as the proportion of centers with a partial paramedic team significantly increased between 2012 (25.0%) and 2016 (69.2%) (p < 0.05). In terms of the point prevalent cases of patients (aged < 18 years), data from the survey of 39 registered centers revealed that the number of children with ESRD who were on RRT was 578 (49% received a kidney transplant) at the end of 2016, which was more than that reported in previous surveys. Data from the registry showed that 349 dialysis patients had been enrolled as of the end of 2016. The median age at RRT start was 9.5 years, and the leading cause of ESRD was congenital abnormalities of the kidney and urinary tract (CAKUT). CONCLUSIONS The IPDN-China has helped to promote the development of pediatric dialysis for ESRD in China by improving the organization of care for dialysis patients and increasing the availability and the quality of RRT for patients who need it. To improve knowledge about the epidemiology and outcomes of pediatric RRT around the country, a sustained effort needs to be made by the IPDN-China to increase the enrollment of dialysis patients and increase the number of registered centers in the future.
Collapse
Affiliation(s)
- Yihui Zhai
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China
| | - Xiaorong Liu
- Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China
| | - Qing Yang
- Division of Nephrology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiqiang Dang
- Division of Pediatric Nephrology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shuzhen Sun
- Division of Pediatric Nephrology, Shandong Provincial Hospital, Jinan, China
| | - Xiaoshan Shao
- Division of Nephrology, Guiyang Children's Hospital, Guiyang, China
| | - Xuemei Liu
- Division of Nephrology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Yubin Wu
- Division of Pediatric Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Haitao Bai
- Division of Pediatric Nephrology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Jianhua Mao
- Division of Nephrology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Dong
- Division of Nephrology, Anhui Provincial Children's Hospital, Hefei, China
| | - Qingshan Ma
- Division of Pediatric Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Guogui Kang
- Division of Pediatric Nephrology, Ningbo Women and Children's Hospital, Ningbo, China
| | - Wenyan Huang
- Division of Nephrology, Shanghai Children's Hospital, Shanghai, China
| | - Hongtao Zhu
- Division of Pediatric Nephrology, The First Hospital of Xinjiang Medical University, Urumqi, China
| | - Rui Fu
- Division of Nephrology, Jiangxi Children's Hospital, Nanchang, China
| | - Aihua Zhang
- Division of Nephrology, Nanjing Children's Hospital, Nanjing, China
| | - Ruiying Xu
- Division of Pediatric Nephrology, Qilu Hospital of Shandong University, Jinan, China
| | - Qing Sun
- Division of Pediatric Nephrology, Qingdao Women and Children's Hospital, Qingdao, China
| | - Xiaoyun Jiang
- Division of Pediatric Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liwen Lai
- Division of Pediatric Nephrology, The third People's Hospital of Jingdezhen, Nanchang, China
| | - Jianping Huang
- Division of Nephrology, Bayi Children's Hospital, The Military General Hospital of Beijing PLA, Beijing, China
| | - Jiangwei Luan
- Division of Pediatric Nephrology, Wuhan Women and Children's Hospital, Wuhan, China
| | - Zhengkun Xia
- Division of Pediatric Nephrology, National Clinical Research Center of Kidney Disease, Jinlin Hospital, Nanjing, China
| | - Jianjun Cui
- Division of Nephrology, Shanxi Children's Hospital, Taiyuan, China
| | - Mengzhun Zhao
- Division of Pediatric Nephrology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiaolin Wu
- Division of Pediatric Nephrology, Hubei Women and Children's Hospital, Wuhan, China
| | - Qiuye Zhang
- Division of Pediatric Nephrology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yufeng Li
- Division of Pediatric Nephrology, Xin Hua Hospital Affiliated, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cuihua Liu
- Division of Nephrology, Henan Children's Hospital, Henan, China
| | - Mo Wang
- Division of Nephrology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feiyan Wang
- Division of Nephrology, Urumqi Children's Hospital, Urumqi, China
| | - Yuhong Tao
- Division of Pediatric Nephrology, West China Second University Hospital, Chengdu, China
| | - Zhimin Huang
- Division of Pediatric Nephrology, The Affiliated Hospital of Guangdong University, Guangzhou, China
| | - Dongfeng Zhang
- Division of Nephrology, Children's Hospital of Hebei Province, Shijiazhuang, China
| | - Bo Zhao
- Division of Nephrology, Kunming Children's Hospital, Kunming, China
| | - Chaoying Chen
- Division of Nephrology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Chunlin Huang
- Division of Nephrology, The Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xia Gao
- Division of Pediatric Nephrology, Gansu Provincial Hospital, Lanzhou, China
| | - Qian Shen
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China.
| | - Ying Shen
- Division of Nephrology, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Rd., West City District, Beijing, 100045, People's Republic of China.
| | - Hong Xu
- Division of Nephrology, Shanghai Kidney Development and Pediatric Kidney Disease Research Center, Children's Hospital of Fudan University, No. 399 Wanyuan Rd, Shanghai, 201102, People's Republic of China.
| | | |
Collapse
|
10
|
Brewer ED. ESRD Policies and the Delivery of Pediatric Long-term Dialysis Care in the United States. Am J Kidney Dis 2020; 77:264-267. [PMID: 32920156 DOI: 10.1053/j.ajkd.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Eileen D Brewer
- Pediatric Renal Section, Department of Pediatrics, Baylor College of Medicine and Renal Service, Texas Children's Hospital, Houston, TX.
| |
Collapse
|
11
|
Fischer MJ, Lash JP. Burden of Psychiatric Illness in Patients with ESKD. Clin J Am Soc Nephrol 2019; 14:1283-1285. [PMID: 37128119 PMCID: PMC6730504 DOI: 10.2215/cjn.08190719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Michael J. Fischer
- Center of Innovation for Complex Chronic Healthcare, Research Service, Edward Hines Jr. Veterans Affairs Medical Center, Hine, Illinois
- Renal Section, Medical Service, Jesse Brown VAMC, Chicago, Illinois; and
- Division of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| | - James P. Lash
- Division of Nephrology, Department of Medicine, University of Illinois Hospital and Health Sciences Center, Chicago, Illinois
| |
Collapse
|
12
|
Torricelli FCM, Watanabe A, Piovesan AC, David-Neto E, Nahas WC. Urologic issues in pediatric transplant recipients. Transl Androl Urol 2019; 8:134-140. [PMID: 31080773 DOI: 10.21037/tau.2018.06.17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The limited supply of kidneys for pediatric transplantation leads to a large number of children in waiting transplant list. These patients have to be properly evaluated and prepared before organ transplantation to increase its success. The aim of this review is focus on urologic issues of pediatric kidney transplants such as preoperative evaluation and urinary tract abnormalities correction, surgical technique, and postoperative complications. All children that are candidates for kidney transplantation should be submitted to abdominal ultrasound. If bladder dysfunction is suspected, a more detailed evaluation is mandatory, including a voiding cystourethrography and urodynamic study. Patients with a poor bladder capacity and compliance will require bladder augmentation. Whenever possible the native ureter is recommended for that. Regarding kidney transplantation, recipient surgery can be safely performed through an extraperitoneal access, even in children weighting less than 10 kilograms. It allows adequate access to iliac vessels, aorta and vena cava. Graft survival continued to improve over the past decade and it is around 80% in 5 years. Postoperative complications such as urinary fistula may occur in less than 5% of cases, while vascular complications are reported in 1% to 2% of cases.
Collapse
Affiliation(s)
- Fabio C M Torricelli
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Andrea Watanabe
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Affonso C Piovesan
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - Elias David-Neto
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| | - William C Nahas
- Division of Urology, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, SP, Brazil
| |
Collapse
|
13
|
Gotta V, Pfister M, Marsenic O. Ultrafiltration rates in children on chronic hemodialysis routinely exceed weight based adult limit. Hemodial Int 2019; 23:126-128. [DOI: 10.1111/hdi.12727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Verena Gotta
- Pediatric Pharmacology & Pharmacometrics; University of Basel Children's Hospital; Basel Switzerland
| | - Marc Pfister
- Pediatric Pharmacology & Pharmacometrics; University of Basel Children's Hospital; Basel Switzerland
| | - Olivera Marsenic
- Pediatric Nephrology, Department of Pediatrics; Yale University School of Medicine; New Haven Connecticut
| |
Collapse
|
14
|
Sánchez-González C, Gonzalez-Casaus ML, Sellares VL, Albalate M, Torregrosa JV, Mas S, Ortiz A, Rodriguez M, Gonzalez-Parra E. Higher Proportion of Non-1-84 PTH Fragments in Peritoneal Dialysis Patients Compared to Hemodialysis Patients Using Solutions Containing 1.75 mmol/l Calcium. Front Physiol 2018; 9:1643. [PMID: 30524306 PMCID: PMC6262178 DOI: 10.3389/fphys.2018.01643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/30/2018] [Indexed: 11/13/2022] Open
Abstract
Background: The prevalence of low- turnover bone disease (LTBD) in peritoneal dialysis (PD) patients is higher than in hemodialysis (HD) patients. LTBD patients may be at risk for vascular calcification, and cardiovascular disease. Current therapy for chronic kidney disease metabolic bone disorders (CKD-MBD) is guided by biochemical parameters, as bone biopsy is not used in routine clinical care. Methods: We assessed intact PTH (iPTH: 1-84PTH plus non-1-84PTH), 1-84PTH, and the 1-84PTH/non-1-84PTH ratio in 129 hemodialysis and 73 PD prevalent patients dialyzed with solutions containing 1.75 mmol/L calcium. Results: Hemodialysis and PD patients presented similar iPTH and tCa values and prevalence of putative LTBD as defined according to KDOQI iPTH cut-off levels or 1-84 PTH levels. However, iCa accounted for a higher percentage of tCa in PD (53%) than in hemodialysis (39%) p < 0.001, and the 1-84PTH/non-1-84PTH ratio was lower in PD than in hemodialysis patients (0.44 ± 0.12) vs. (0.60 ± 0.10), p < 0.001. The prevalence of putative LTBD when using the coexistence of 1-84PTH/non-1-84PTH ratio < 1.0 and iPTH < 420 pg/m, was higher in PD than in hemodialysis patients (73 vs. 16% respectively, p < 0.001). In a multivariate logistic regression analysis, dialysis modality was the main determinant of the 1-84PTH/non-1-84PTH ratio. Conclusion: Solutions containing 1.75 mmol/L calciums are associated to a higher proportion of non-1-84PTH fragments in PD than in HD patients. Different analytical criteria result in widely different estimates of LTBD prevalence, thus impairing the ability of clinicians to optimize therapy for CKD-MBD.
Collapse
Affiliation(s)
| | | | | | | | | | - Sebastian Mas
- Unidad de Diálsis IIS Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Alberto Ortiz
- REDINREN, Madrid, Spain
- Unidad de Diálsis IIS Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Mariano Rodriguez
- REDINREN, Madrid, Spain
- Nefrología y Unidad de Investigación, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - Emilio Gonzalez-Parra
- REDINREN, Madrid, Spain
- Unidad de Diálsis IIS Fundación Jiménez Díaz, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
15
|
Nelms CL. Optimizing Enteral Nutrition for Growth in Pediatric Chronic Kidney Disease (CKD). Front Pediatr 2018; 6:214. [PMID: 30116725 PMCID: PMC6083216 DOI: 10.3389/fped.2018.00214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
Growth in pediatric Chronic Kidney Disease is important for long-term outcomes including final adult height and cognitive function. However, there are many barriers for children with chronic kidney disease to achieve adequate nutritional intake to optimize growth. This review highlights these unique concerns, including route of nutrition, dialysis contributions and biochemical indices. Fitting the enteral feeding to the patients' needs involves choosing an appropriate product or products, limiting harmful nutrients in excess, notably aluminum, and altering for electrolyte and micronutrient needs. Unique adjustments to the enteral regimen include accommodating volume needs, optimizing macronutrient ratios, specific electrolyte adjustments, the blending of products together, and adjustments made to consider patient and family psychosocial needs. When a holistic approach to medical nutrition therapy is applied, taking the above factors into consideration, adequate intake for growth of the child with CKD is achievable.
Collapse
Affiliation(s)
- Christina L. Nelms
- PedsFeeds, Kearney, NE, United States
- Department of Family Studies, University of Nebraska System, Kearney, NE, United States
| |
Collapse
|