Meeting Nutritional Goals for Children Receiving Maintenance Dialysis

Mortality Risk Among Children Initially Treated With Dialysis for End-Stage Kidney Disease, 1990-2010

“…Improved predialysis care, advances in dialysis technology, and greater experience of clinicians may each have played a role. 17–20 We were limited in our ability to examine predialysis care by the information available in this comprehensive US ESKD registry. Large proportions of patients—particularly younger children and those initiating treatment in earlier years—had data missing for ESA use prior to and for eGFR at initiation of dialysis.…”

A Review of Pediatric Chronic Kidney Disease

“…Puberty onset is often delayed by about 2 years. The pubertal growth spurt is limited by a reduced height velocity and duration [11] , and this period of accelerated growth is often a time of more rapid renal function decline. Possible mechanisms include an increased glomerular filtration demand pitted against residual nephron mass and changes in hormonal physiology.…”

“…EPO production by the kidneys also declines with CKD progression. It does not induce erythrocyte proliferation; rather it suppresses erythroid cell apoptosis, which begins when the cells are deprived of EPO for a time as short as 2 h [11] . Administration of recombinant human erythropoietin (rHuEpo) IV 3 times weekly helps patients avoid red blood cell transfusions.…”

“…encephalopathy, seizures, foot drop), pericarditis, bleeding diathesis, refractory nausea or hypertension, and so on. [11] . Malnutrition, or the inability to deliver full nutrition, is also a strong indicator to begin dialysis.…”

“…Pediatric patients on dialysis require additional parenteral and enteral iron to maintain stores [11] . Hepcidin, a peptide produced by the liver, prevents absorption of iron into the circulation and is elevated in CKD and dialysis patients, which may explain the relative resistance to oral iron therapy.…”