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Optimal care of the infant, child, and adolescent on dialysis: 2014 update
Bradley A Warady1, Alicia M Neu2, Franz Schaefer3
1Children's Mercy Hospital, Kansas City, MO.
Insights
Optimal pediatric dialysis care requires a multidisciplinary approach addressing growth, bone health, and quality of life. This review updates management strategies for infants, children, and adolescents on long-term dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Child Health
Background:
- Long-term dialysis in pediatric patients presents complex clinical challenges beyond solute and fluid management.
- Optimal care necessitates addressing growth, anemia, bone disease, cardiovascular health, nutrition, education, and psychosocial development.
Purpose of the Study:
- To review current management recommendations for pediatric patients undergoing long-term dialysis.
- To highlight advances in understanding and therapeutics for pediatric dialysis care.
- To provide guidance for optimal patient management.
Main Methods:
- Synthesis of published guidelines.
- Analysis of pediatric renal registry data.
- Incorporation of expert clinical experience.
Main Results:
- Current recommendations emphasize a multidisciplinary team approach.
- Significant advancements have been made in pediatric dialysis care over the past decade.
- Key areas include managing growth, anemia, osteodystrophy, cardiovascular health, and psychosocial factors.
Conclusions:
- Optimal care for pediatric dialysis patients requires comprehensive management of multifaceted clinical issues.
- A multidisciplinary strategy is crucial for addressing the unique needs of these young patients.
- Continuous updates in therapeutic approaches are essential for improving outcomes in pediatric dialysis.
Abstract:
Providing optimal care to the infant, child, and adolescent patient who is treated with long-term dialysis therapy mandates that attention be directed to a variety of clinical issues in addition to those related to solute removal and fluid management. Therapeutic plans must be formulated by a multidisciplinary team of pediatric specialists to address the clinical parameters of growth, anemia and osteodystrophy management, cardiovascular health, nutritional adequacy, education, cognitive development, quality of life, preparation for transplantation, and transition to adult care. This review highlights key components of current management recommendations based on a combination of published guidelines, pediatric registry data, and the combined clinical experience of the authors. Whereas some components of this review reflect a modification of the content and recommendations contained in the original publication from more than a decade ago, the contrast emphasizes the advances in understanding and therapeutics of many aspects of pediatric dialysis care that have taken place in the interim. In turn, the content of this article should provide the reader with valuable guidance toward the goal of providing optimal care to patients receiving dialysis.
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