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Optimal care of the pediatric end-stage renal disease patient on dialysis
B A Warady1, S R Alexander, S Watkins
1The Children's Mercy Hospital, Kansas City, MO 64108, USA. bwarady@cmh.edu
Insights
This guideline offers recommendations for optimizing care for children with end-stage renal disease (ESRD). It emphasizes individualized dialysis initiation, regular efficacy monitoring, and a multidisciplinary approach for better patient outcomes.
Area of Science:
- Pediatric Nephrology
- Renal Disease Research
Background:
- End-stage renal disease (ESRD) in children presents unique challenges requiring specialized care guidelines.
- Current clinical practices for pediatric ESRD necessitate optimization for improved patient outcomes.
Purpose of the Study:
- To provide evidence-based and opinion-based recommendations for the clinical management of pediatric patients with ESRD.
- To guide healthcare professionals in optimizing the care and treatment of children suffering from end-stage renal disease.
Main Methods:
- Development of recommendations by the American Society of Pediatric Nephrology.
- Synthesis of existing evidence from patient registries and clinical experience.
- Consensus-based approach incorporating both data-driven and expert opinion.
Main Results:
- Recommendations for assessing biochemical and clinical characteristics before initiating dialysis.
- Emphasis on regular measurement of dialysis efficacy and achieving target clearances.
- Mandatory attention to dialysis adequacy, osteodystrophy control, nutrition, and anemia correction.
Conclusions:
- Individualized assessment is crucial for initiating dialysis in pediatric ESRD patients.
- Consistent monitoring of dialysis adequacy and addressing key factors like nutrition and anemia are vital for growth and development.
- A multidisciplinary team approach, including renal transplantation, is essential for comprehensive pediatric ESRD care.
Abstract:
This manuscript is an effort on behalf of the American Society of Pediatric Nephrology to provide recommendations designed to optimize the clinical care of pediatric patients with end-stage renal disease (ESRD). Although many of the recommendations are evidenced-based with the supporting data being derived from a variety of sources, including patient registries, others are opinion-based and derived from the combined clinical experience of the authors. In all cases, it is recommended that the decision to initiate dialysis should be made only after an assessment of a combination of biochemical and clinical characteristics. Irrespective of the choice of dialysis modality (hemodialysis v peritoneal dialysis), dialysis efficacy should be measured regularly, and the dialysis prescription should be designed to achieve target clearances. Attention to dialysis adequacy, control of osteodystrophy, nutrition, and correction of anemia is mandatory, because all may influence patient outcome in terms of growth, cognitive development, and school performance. Finally, the availability of a multidisciplinary team of pediatric specialists is desirable to provide all facets of pediatric ESRD care, including renal transplantation, in an optimal manner. Future clinical research efforts intended to address topics such as dialysis adequacy, anemia management, and growth should be encouraged.