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Management of end-stage renal disease in children
1University of Tennessee, Department of Pharmacy, College of Pharmacy, Knoxville, USA.
Insights
Pediatric end-stage renal disease (ESRD) management requires specialized care, focusing on renal replacement therapy and addressing complications like anemia and growth issues. Pharmacists play a crucial role in optimizing drug therapy and patient education for children with ESRD.
Area of Science:
- Pediatric Nephrology
- Clinical Pharmacy
- Renal Disease Management
Background:
- End-stage renal disease (ESRD) in children presents unique management challenges.
- Pediatric ESRD requires specialized renal replacement therapy and intensive medication regimens.
Purpose of the Study:
- To review the medical literature on the management of pediatric end-stage renal disease (ESRD).
- To focus on drug therapy for ESRD complications in children.
Main Methods:
- MEDLINE searches of English-language literature from 1970-1997.
- Inclusion of clinical trials and reviews on drug therapy management.
- Review of bibliographies for relevant articles.
Main Results:
- Renal replacement therapy principles for children include fluid/electrolyte balance and complication management.
- Key complications addressed include anemia, growth retardation, and hypertension.
- Recommendations provided for vitamin/supplement use and vaccinations in pediatric ESRD patients.
Conclusions:
- Children with ESRD require intensive medication regimens and close monitoring by pharmacists.
- Pharmacists are vital in optimizing drug therapy, managing complications, and enhancing patient/family education and compliance.
- Collaboration between pharmacists and the healthcare team is essential for improved outcomes in pediatric ESRD.
Objective:
To review the medical literature on management of end-stage renal disease (ESRD) and its complications in the pediatric patient.
Data Sources And Study Selection:
MEDLINE searches (1970-1997) of the English-language literature. Clinical trials and reviews of drug therapy management were included, and bibliographies were reviewed for relevant articles.
Data Synthesis:
Principles of renal replacement therapy in children have been expanded to include maintenance of fluid and electrolyte balance and to manage the complications of ESRD in children. Types of renal replacement and their complications are reviewed. Complications of ESRD are reviewed with emphasis on drug therapy management of anemia of chronic renal failure, growth retardation, and hypertension. A discussion of the use of vitamins and supplements to maintain bone and mineral homeostasis is provided, and specific recommendations for vaccination of children with ESRD are given.
Conclusions:
Children with end-stage renal failure present a unique challenge to the pharmacist. Renal replacement therapy for children with ESRD involves some form of dialysis and an intensive medication regimen. Complications must be treated with appropriate drug therapy. Drug therapy must be monitored closely for dosage adjustment, clinical response, drug interactions, and toxicity. Patients and families must receive continuous education and follow-up to encourage compliance. The pharmacist must work closely with the healthcare team to optimize drug therapy and improve patient education and compliance.