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Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report
Alicia M Neu1, P L Martin Ho, Ruth A McDonald
1The Jhons Hopkins University School of Medicine, Baltimere, Maryland, USA. aneu@jhmi.edu
Insights
Pediatric dialysis care has evolved, with increased use of advanced peritoneal dialysis catheters and improved hemodialysis access. Erythropoietin use is now standard, leading to better patient hematocrit levels.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Technology
Background:
- The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry tracks pediatric dialysis patients.
- Understanding trends in dialysis care is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze trends in dialysis modalities and access in pediatric patients from the NAPRTCS registry.
- To evaluate changes in medication use and hematocrit levels over time.
Main Methods:
- Analysis of data from the NAPRTCS registry, covering 4,546 pediatric dialysis patients.
- Comparison of dialysis initiation data between two periods: 1992-1996 and 1997-2000.
Main Results:
- Increased use of dual-cuff peritoneal dialysis catheters, Swan neck tunnels, and downward-pointing exit sites.
- Higher utilization of jugular veins for hemodialysis access and near-universal erythropoietin prescription by 1996.
- Significant improvement in median hematocrit levels at 6 months post-dialysis initiation.
Conclusions:
- Pediatric dialysis care has seen significant advancements in catheter technology and vascular access.
- Erythropoietin therapy has become standard, effectively improving anemia management in pediatric dialysis patients.
Abstract:
The 2001 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) registry includes data on 4,546 dialysis patients. Important trends in dialysis care include a significant increase in the use of peritoneal dialysis catheters with two cuffs (51.6% vs. 36.2%, P<0.001), a Swan neck tunnel (34.1% vs. 20.9%, P<0.001), and a downward pointing exit site (34.9% vs. 29.5%, P<0.001) in patients who initiated dialysis between 1997 and 2000 compared with 1992-1996. Most hemodialysis patients continued to have an external percutaneous catheter as their access at the time of initiation of dialysis (1,550/1,971 patients, 78.6%), but the odds of using a jugular rather than a subclavian vein for these catheters increased by 24% each year between 1992 and 2000. There was a significant trend for increasing use of erythropoietin and by 1996, 96% of patients were prescribed this medication at initiation of dialysis. There was also a modest, but significant, increase in hematocrit in the dialysis registry, as the median hematocrit at 6 months of follow-up was 31% in patients who started dialysis between 1997 and 2000 ( P<0.001).