Chronic dialysis in children and adolescents

Abstract

The 1996 annual report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) summarizes data submitted from 130 centers on 2,208 patients in whom 2,787 independent courses of dialysis were performed between 1 January 1992 and 16 January 1996. Approximately two-thirds of the dialysis population were maintained on peritoneal dialysis (PD), with automated PD remaining the preferred modality. There were 964 episodes of peritonitis in 1,018 patient years, yielding an overall peritonitis rate of 1 episode every 13 patient months. More PD patients attended school full time than hemodialysis (HD) patients at baseline (77% vs. 45%), which continued at 6, 12, and 24 months of followup. There were fewer Hispanic patients who were full-time students, whether on HD or PD, compared with white or black patients; 18% of Hispanic patients did not attend school, even though they were medically capable. The majority of dialysis courses terminated due to transplantation (54%), with change in dialysis modality the next most-common reason (28%). Early dialysis termination for any reason was seen more often in HD than PD (40% vs. 23% at 6 months), but by 24 months similar percentages of PD and HD courses had been terminated (75% HD, 72% PD). The most-common PD access was a Tenckhoff catheter with a single cuff, a straight tunnel and lateral exit site. The majority of HD accesses were external percutaneous catheters, with the sublcavian vein the most-common site. Erythropoietin was administered in 93% of HD and PD patients at 24 months.

Merit of the cuff-shaving procedure in children with tunnel infection

“…From the reports of Lerner et al [18] and Warady et al [19], Verrina et al [23] have recommended two-cuffed rather than one-cuffed catheters to minimize the risk of peritonitis. Once the two-cuffed catheter is deroofed, the condition becomes the same as a one-cuffed catheterization.…”

Hypertension and Left Ventricular Hypertrophy in Pediatric Peritoneal Dialysis Patients: Ambulatory Blood Pressure Monitoring and Echocardiographic Evaluation

“…According to the results of the North-American Pediatric Renal Transplant Cooperative study 54% of PD patients required antihypertensive medication at the initiation of dialysis and 40% still required medication at 2 years [15]. After the investigation of ABPM, studies evaluating patients with chronic renal insufficiency, dialysis and renal transplantation showed that ABPM data were superior to casual BP recordings while appraising hypertension in these patients [6, 16, 17].…”

Incidence and clinical implication of nosocomial infections associated with implantable biomaterials – catheters, ventilator-associated pneumonia, urinary tract infections

“…An antibiotic lock of Sheldon-catheters in intervals between haemodialysis procedures has been shown to reduce the incidence of sepsis and increase the success of systemic antibiotic treatment of in line sepsis. The rate of vascular access infection is generally 3 per 100 patient-months and varies from 0.6 for fistulas to 10.1 for temporary catheters [70], [71], [72]. Prophylactic measures include antibiotic locks with various antibiotic regimens [73].…”

“…Potential risk factors were significantly correlated with two or more of the outcome indices: age, APD treatment, exit-site infections, low urinary volume, low residual GFR and low nPCR [82]. Lerner et al reported 964 episodes of peritonitis in 1,018 patient years, yielding an overall peritonitis rate of 1 episode every 13 patient months [72]. In contrast to this exceedingly high incidence Troidle et al observed a frequency of 5%.…”