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Chronic hemodialysis in pediatric patients: technical and practical aspects of use

L A Harshman1, M L Neuberger, P D Brophy

  • 1Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA, USA.

Minerva Pediatrica
|April 13, 2012
PubMed

Insights

Pediatric chronic kidney disease (CKD) management involves renal supportive therapy (RST) using various dialysis methods. Flexible use of hemodialysis, peritoneal dialysis, and home hemodialysis is key for effective pediatric care.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Renal Replacement Therapy

Background:

  • Chronic kidney disease (CKD) is a progressive decline in kidney function, potentially leading to irreversible damage.
  • Renal supportive therapy (RST) encompasses dialysis treatments to support kidney function in CKD patients nearing end-stage renal disease (ESRD) or awaiting transplantation.
  • Established RST modalities include conventional hemodialysis, peritoneal dialysis, and home hemodialysis.

Purpose of the Study:

  • To provide an overview of current management and technical approaches for pediatric patients undergoing chronic hemodialysis.
  • To discuss the factors influencing the choice of RST modality in pediatric populations.
  • To highlight the need for flexible utilization of multiple RST delivery modalities for effective pediatric care.

Main Methods:

  • Review of current literature on pediatric chronic kidney disease and renal supportive therapy.
  • Analysis of factors influencing RST modality selection in pediatric patients.
  • Discussion of technical aspects of chronic hemodialysis in infants and children.

Main Results:

  • The selection of RST modality in pediatric patients is influenced by institutional resources, expertise, patient characteristics, treatment goals, and physician preference.
  • Chronic RST in pediatric populations necessitates adaptable use of multiple modalities to ensure effective care from infancy through adulthood.
  • RST initiation typically occurs when glomerular filtration rate (GFR) declines to 15-30 mL/min per 1.73 m2, with variations based on individual patient needs.

Conclusions:

  • Effective management of pediatric CKD requires a flexible, multi-modal approach to renal supportive therapy.
  • Understanding the factors guiding RST modality choice is crucial for optimizing care in pediatric patients.
  • This review offers insights into current strategies for managing pediatric patients on chronic hemodialysis.

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