Gorman G et al. (2006) Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients. Am J Kidney Dis 47: 285–293

According to the K/DOQI GUIDELINES, adult hemodialysis patients should be given a minimum dialysis dose (as single-pooled Kt/V [spKt/V]) ≥1.2. Gorman et al. have demonstrated, in a large, retrospective cohort study, that this minimum dose is also appropriate for children aged 12–18 years.

The characteristics of 613 patients aged 12–18 years from the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to data from the US Renal Data System from 1999–2001. There were 14 deaths during 695 patient-years of follow-up, and 185 hospitalizations totaling 1,108 days during 477 patient-years of follow-up. The mean spKt/V was 1.48 ± 0.36. Following adjustment for confounders, patients who received a dose <1.2 experienced a significantly greater number of hospitalizations and days hospitalized than patients who received ≥1.2 (P = 0.06 and P <0.05, respectively). The unadjusted mortality rate was also higher in the lower-dose group, although the difference was not statistically significant—4.4 deaths/100 patient-years vs 1.5 deaths/100 patient-years. Further improvement was observed at doses of 1.2–1.4, but not at doses >1.4. The authors therefore recommend 1.2–1.4 spKt/V as the optimum dialysis dose.

This study helps to address the dearth of guidance regarding dialysis in adolescents. Further studies, however, are needed over a longer follow-up period, and in children aged <12 years.