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[Experience with long-term care of dialyzed children and children with kidney transplants]
Insights
This study reviews the integrated care of 197 children with chronic renal insufficiency from 1969-1980. A preventive approach is crucial throughout all treatment stages for pediatric end-stage renal disease.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Chronic Kidney Disease Management
Context:
- Growing number of children with end-stage renal failure.
- Experience in pediatric renal care has advanced.
- Longitudinal study (1969-1980) at a major children's hospital.
Purpose:
- Summarize treatment of 197 children with chronic renal insufficiency.
- Describe an integrated care concept adjusted to disease stage.
- Facilitate smooth transitions between therapeutic stages.
Summary:
- Details conservative treatment, hospital dialysis, home dialysis, and transplantation.
- Discusses medical and psychosocial challenges in end-stage renal failure.
- Highlights home dialysis advantages and stresses, and transplantation's benefits and burdens.
Impact:
- Emphasizes a preventive clinical and psychological approach for pediatric renal failure.
- Provides insights into long-term management of pediatric chronic kidney disease.
- Informs strategies for optimizing quality of life in children undergoing renal replacement therapy.
Abstract:
By the increasing number of children with terminal renal failure the experience in the care of these patients has grown. In this paper the treatment of 197 children with chronic renal insufficiency observed from 1969 to 1980 at the University Children's Hospital in Heidelberg is summarized. A concept of integrated care adjusted to the stage of the disease was adopted. Emphasis is given to obtain a smooth transition from one therapeutic stage (conservative treatment, hospital dialysis, home dialysis, transplantation) to another. The clinical course of the patients including death is presented. The main medical and psychosocial problems arising at the end-stage of renal failure are discussed: the indications for continuing therapy, the choice of vascular access for dialysis and the form of dialysis treatment. The advantages of home dialysis as well as its stress on child and parents are underlined. The main role of dialysis is to prepare the child for transplantation and to replace renal function in the meantime. In spite of the obvious advantages of transplantation in allowing an improved quality of life, the somatic and psychologic stress involved should be kept in mind. We conclude that during all therapeutic stages passed by children with chronic renal failure a preventive approach should be favoured from the clinical as well as from the psychological point of view.