Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Mekahli, Djalila; Shaw, Vanessa; Ledermann, Sarah; Rees, Lesley

doi:10.2215/cjn.05600809

Cited by 87 publications

(68 citation statements)

References 36 publications

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“…However, the increasing experience of specialist units and the advent of chronic peritoneal dialysis in the 1980s enabled children to be treated successfully at home and at some distance from tertiary paediatric renal centres [5,6]. Such is the current expertise that in those units that have the resources, RRT can be offered from birth [7,8]. Increasingly, ethical dilemmas arise in relation to the treatment of those with comorbidities or syndromes [9,10].…”

Section: Introductionmentioning

confidence: 99%

Psychosocial support for children and families requiring renal replacement therapy

Watson

2013

Pediatr Nephrol

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Chronic kidney disease (CKD) and the need for renal replacement therapy (RRT) can place a great strain on the child and family. As well as the medical and nutritional prescription, each child and family requires an individual psychosocial prescription that requires input from multiprofessional team members. The information needs of each child and family need to be constantly evaluated as well as the choice of therapy in relation to social, psychological and economic factors. Many tertiary units lack adequate "time" to deliver such assessments and coordinate the support and respite care for those on long-term dialysis, especially when significant numbers of children are now accepted onto RRT programmes with co-morbidities. National and international standards are needed for the staffing of comprehensive tertiary paediatric renal units as well as studies evaluating supportive care to families.

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Section: Introductionmentioning

confidence: 99%

Psychosocial support for children and families requiring renal replacement therapy

Watson

2013

Pediatr Nephrol

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“…3,5,6,8,22 No entanto, alguns estudos descrevem que em crianças em DP com idade inferior a dois anos sem comorbilidades associadas, a sobrevida é semelhante à das crianças mais velhas. 10,13,14,23 Relativamente à DP, oito das 14 crianças (57%) iniciaram diálise antes dos seis meses de vida, seis delas (43% do total das 14) no primeiro mês de vida. Todas as crianças realizaram dialise automatizada noturna intermitente, o que permite uma maior autonomia do doente e da sua família, conduzindo a uma maior aceitação.…”

Section: Discussionunclassified

“…A presença de anúria agrava o prognóstico, aumentando 7,5 vezes o risco de morte. 9,14,23 Relativamente às dez crianças transplantadas, verificou-se um impacto positivo na nossa amostra com Tabela 5 -Avaliação do z-score do índice de massa corporal das quatro crianças que se mantinham em diálise peritoneal no final do estudo: ao nascimento, no início da diálise peritoneal, à data do transplante renal e no final do estudo (segundo as curvas de crescimento da OMS).…”

Section: Discussionunclassified

“…6,7,12, A incidência de complicações da técnica é mais elevada, sendo as peritonites e as infeções associadas ao cateter as mais frequentes. 2,9,11,13,14 A taxa de mortalidade abaixo dos dois anos é até 55 vezes mais elevada que noutras idades pediátricas, embora séries recentemente publicadas revelem uma mudança nesta tendência associada à melhoria nos cuidados. 2,8,11,12 A mortalidade associa-se, mais do que à técnica, à presença de comorbilidades como cardiopatia, hipoplasia pulmonar e perturbações do desenvolvimento psicomotor.…”

Section: 4unclassified

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Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Deuchande¹,

Mano

Novais³

et al. 2016

Acta Med Port

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Introduction:Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life. Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated. Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay. Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers. Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

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“…However, interpolation of the early growth response until the time of final height provided a too optimistic view [8], and analysis of the same patients 10 years later showed disappointing results [9]. Despite optimal nutrition, growth remained suboptimal in many young patients, although they became obese [10].…”

Section: Growth Before End-stage Renal Diseasementioning

confidence: 99%

Growth hormone treatment after renal transplantation: a promising but underused chance to improve growth

Mehls

Fine

2012

Pediatr Nephrol

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Growth retardation remains a clinical problem in children with chronic kidney disease (CKD) prior to and during end-stage renal disease. The growth of approximately 40 % of children on dialysis is stunted. Even so, growth hormone treatment (GH) is not used in the majority of small children prior to transplantation. Also, GH is effective in improving growth after transplantation, but again, it is only rarely used in this situation mainly for fear of triggering rejection episodes. In controlled studies, the number of patients who developed rejection episodes with GH was no greater than the number in untreated controls. However, patients with prior frequent rejection episodes developed further repeated subsequent rejection episodes. Many patients with repeated rejection episodes before GH treatment have reduced renal function and are expected to proceed to dialysis or retransplantation. We believe that in these patients, early individual decisions for or against GH treatment should be made as soon as other treatment strategies, such as steroid withdrawal, have failed or are not indicated. Decisions for GH treatment at a later pubertal age come too late for significant growth response and/or improvement of final height.

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Long-Term Outcome of Infants with Severe Chronic Kidney Disease

Cited by 87 publications

References 36 publications

Psychosocial support for children and families requiring renal replacement therapy

Psychosocial support for children and families requiring renal replacement therapy

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Growth hormone treatment after renal transplantation: a promising but underused chance to improve growth

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