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The first 10 years of the dialysis-transplantation program at The Hospital for Sick Children, Toronto. 1: Predialysis
Insights
Pediatric renal dialysis and transplantation programs require specialized vascular access techniques and equipment. Expert medical staff are crucial for successfully treating children with kidney failure.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Renal dialysis and transplantation are established treatments for adult kidney failure.
- Pediatric application of these therapies is a more recent development.
Purpose of the Study:
- To describe the establishment and early outcomes of a pediatric renal dialysis and transplantation program.
- To highlight the specific challenges and considerations for treating children with kidney failure.
Main Methods:
- Establishment of a dedicated renal dialysis and transplantation program at The Hospital for Sick Children, Toronto.
- Inclusion criteria evolved to encompass children aged 1 to 18 years.
- Focus on specialized vascular access (central shunts, bovine grafts) and adapted dialysis equipment.
Main Results:
- The program admitted 90 children from across Canada by August 1977.
- Mean age of admitted children was 11 years.
- Central shunts and bovine grafts proved successful for vascular access in small patients.
Conclusions:
- Pediatric renal replacement therapy requires specialized vascular access and equipment.
- Expert medical teams are essential for managing young patients undergoing dialysis and transplantation.
- Careful consideration of patient age and specific needs is paramount for program success.
Abstract:
Renal dialysis and transplantation have been used for many years for adults with kidney failure but only recently for children. In May 1967 a renal-dialysis-transplantation program was established at The Hospital for Sick Children, Toronto for patients aged 6 to 18 years living within 240 km of Toronto. In 1973, children aged 1 to 5 years began to be accepted into the program, and by August 1977, 90 children (mean age 11 years) from all parts of Canada had been admitted to the program. The creation of vascular access in very small patients is difficult; the most successful types of access have been central shunts (established above the knee or the elbow) and bovine grafts. Specially made dialysis equipment is necessary for young patients. Young children should only be accepted in a dialysis-transplantation program that has a medical staff expert in meeting the specific needs of such children.