Abstract
Although renal transplantation remains the most common treatment for children with end-stage renal disease (ESRD), the majority of children incident to ESRD receive dialytic therapy before receiving a renal allograft. Advances in the past decade have led to improved outcomes for children receiving maintenance hemodialysis, the majority of whom survive into adulthood. Medical, surgical, nutritional and psychosocial factors must be considered to provide optimal maintenance hemodialysis for children. In this Review, we discuss the various aspects of providing optimal hemodialysis to children, including vascular access, nutritional status, clearance targets, medications and assessment of health-related quality of life.
Key Points
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The incidence and prevalence of pediatric patients with end-stage renal disease receiving maintenance hemodialysis have increased over the past decade
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Considerations regarding vascular access include the size of the patient's vessels, surgical expertise and expected time on hemodialysis before transplantation
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Aggressive monitoring of nutrition and supplementation is required to optimize growth and development in children receiving hemodialysis
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Intensified hemodialysis regimens might result in improved outcomes
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Health-related quality of life is low for children receiving hemodialysis, but new assessment instruments have been developed to evaluate the effect of an intervention on this health outcome
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References
Broyer, M., Chantler, C., Donckerwolcke, R. & Rizzoni, G. in Replacement of Renal Function by Dialysis: a Textbook of Dialysis (ed. Maher, J. F.) 720–749 (Kluwer Academic Publishers, Boston, 1989).
Broyer, M. et al. The paediatric registry of the European Dialysis and Transplant Association: 20 years' experience. Pediatr. Nephrol. 7, 758–768 (1993).
Vanrenterghem, Y. & Jones, E. H. Report on management of renale failure in Europe, XXVI, 1995. Report based on the Centre Questionnaire, 1995. The ERA-EDTA Registry. Nephrol. Dial. Transplant. 11 (Suppl. 7), 28–32 (1996).
Neu, A. M., Ho, P. L., McDonald, R. A. & Warady, B. A. Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr. Nephrol. 17, 656–663 (2002).
US Renal Data System. 2009 Annual Data Report [online], (2009).
ERA-EDTA Registry. ERA-EDTA Registry Annual Report 2007 [online], (2007).
van Stralen, K. J., Tizard, E. J., Verrina, E., Schaefer, F. & Jager, K. J. for the European Society for Paediatric Nephrology/European Renal Association-European Dialysis and Transplant Association (ESPN/ERA-EDTA) registry study group. Demographics of paediatric renal replacement therapy in Europe: 2007 annual report of the ESPN/ERA-EDTA registry. Pediatr. Nephrol. 25, 1379–1382 (2010).
McDonald, S. P. & Craig, J. C. for the Australian and New Zealand Paediatric Nephrology Association. Long-term survival of children with end-stage renal disease. N. Engl. J. Med. 350, 2654–2662 (2004).
Hattori, S., Yosioka, K., Honda, M. & Ito, H. for the Japanese Society for Pediatric Nephrology. The 1998 report of the Japanese National Registry data on pediatric end-stage renal disease patients. Pediatr. Nephrol. 17, 456–461 (2002).
Hjorth, L., Wiebe, T. & Karpman, D. Correct evaluation of renal glomerular filtration rate requires clearance assays. Pediatr. Nephrol. 17, 847–851 (2002).
Seikaly, M. G., Browne, R., Bajaj, G. & Arant, B. S. Jr. Limitations to body length/serum creatinine ratio as an estimate of glomerular filtration in children. Pediatr. Nephrol. 10, 709–711 (1996).
Schwartz, G. J. et al. New equations to estimate GFR in children with CKD. J. Am. Soc. Nephrol. 20, 629–637 (2009).
Churchill, D. N. An evidence-based approach to earlier initiation of dialysis. Am. J. Kidney Dis. 30, 899–906 (1997).
van Stralen, K. J. et al. Determinants of eGFR at start of renal replacement therapy in paediatric patients. Nephrol. Dial. Transplant. 25, 3325–3332 (2010).
National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy, vascular access. Am. J. Kidney Dis. 48 (Suppl. 1), S1–S322 (2006).
Sheth, R. D. et al. Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int. 62, 1864–1869 (2002).
Brittinger, W. D., Walker, G., Twittenhoff, W. D. & Konrad, N. Vascular access for hemodialysis in children. Pediatr. Nephrol. 11, 87–95 (1997).
Zaritsky, J. J. et al. Vascular access complications in long-term pediatric hemodialysis patients. Pediatr. Nephrol. 23, 2061–2065 (2008).
Goldstein, S. L., Ikizler, T. A., Zappitelli, M., Silverstein, D. M. & Ayus, J. C. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas. Kidney Int. 76, 1063–1069 (2009).
Sheth, R. D. et al. Successful use of Tesio catheters in pediatric patients receiving chronic hemodialysis. Am. J. Kidney Dis. 38, 553–559 (2001).
Goldstein, S. L., Macierowski, C. T. & Jabs, K. Hemodialysis catheter survival and complications in children and adolescents. Pediatr. Nephrol. 11, 74–77 (1997).
Srivaths, P. R., Silverstein, D. M., Leung, J., Krishnamurthy, R. & Goldstein, S. L. Malnutrition-inflammation-coronary calcification in pediatric patients receiving chronic hemodialysis. Hemodial. Int. 14, 263–269 (2010).
Shroff, R. C. et al. Mineral metabolism and vascular damage in children on dialysis. J. Am. Soc. Nephrol. 18, 2996–3003 (2007).
Gotch, F. A. & Sargent, J. A. A mechanistic analysis of the National Cooperative Dialysis Study (NCDS). Kidney Int. 28, 526–534 (1985).
Goldstein, S. L. Adequacy of dialysis in children: does small solute clearance really matter? Pediatr. Nephrol. 19, 1–5 (2004).
Gorman, G. et al. Short stature and growth hormone use in pediatric hemodialysis patients. Pediatr. Nephrol. 20, 1794–1800 (2005).
Tom, A. et al. Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance. J. Pediatr. 134, 464–471 (1999).
Fischbach, M. et al. Intensified and daily hemodialysis in children might improve statural growth. Pediatr. Nephrol. 21, 1746–1752 (2006).
Goldstein, S. L. et al. Acute and chronic inflammation in pediatric patients receiving hemodialysis. J. Pediatr. 143, 653–657 (2003).
Daugirdas, J. T. Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J. Am. Soc. Nephrol. 4, 1205–1213 (1993).
Goldstein, S. L., Sorof, J. M. & Brewer, E. D. Natural logarithmic estimates of Kt/V in the pediatric hemodialysis population. Am. J. Kidney Dis. 33, 518–522 (1999).
Goldstein, S. L., Sorof, J. M. & Brewer, E. D. Evaluation and prediction of urea rebound and equilibrated Kt/V in the pediatric hemodialysis population. Am. J. Kidney Dis. 34, 49–54 (1999).
Daugirdas, J. T. & Schneditz, D. Overestimation of hemodialysis dose depends on dialysis efficiency by regional blood flow but not by conventional two pool urea kinetic analysis. ASAIO J. 41, M719–M724 (1995).
Smye, S. W., Evans, J. H., Will, E. & Brocklebank, J. T. Paediatric haemodialysis: estimation of treatment efficiency in the presence of urea rebound. Clin. Phys. Physiol. Meas. 13, 51–62 (1992).
Goldstein, S. L., Brem, A., Warady, B. A., Fivush, B. & Frankenfield, D. Comparison of single-pool and equilibrated Kt/V values for pediatric hemodialysis prescription management: analysis from the Centers for Medicare & Medicaid Services Clinical Performance Measures Project. Pediatr. Nephrol. 21, 1161–1166 (2006).
Leypoldt, J. K., Jaber, B. L. & Zimmerman, D. L. Predicting treatment dose for novel therapies using urea standard Kt/V. Semin. Dial. 17, 142–145 (2004).
Mammen, C., Goldstein, S. L., Milner, R. & White, C. T. Standard Kt/V thresholds to accurately predict single-pool Kt/V targets for children receiving thrice-weekly maintenance haemodialysis. Nephrol. Dial. Transplant. 25, 3044–3050 (2010).
Boehm, M. et al. Early erythropoietin therapy is associated with improved growth in children with chronic kidney disease. Pediatr. Nephrol. 22, 1189–1193 (2007).
Besarab, A. et al. The effects of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N. Engl. J. Med. 339, 584–590 (1998).
Singh, A. K. et al. for the CHOIR Investigators. Correction of anemia with epoetin alfa in chronic kidney disease. N. Engl. J. Med. 355, 2085–2098 (2006).
André, J. L. et al. Darbepoetin, effective treatment of anaemia in paediatric patients with chronic renal failure. Pediatr. Nephrol. 22, 708–714 (2007).
Warady, B. A. et al. Iron therapy in the pediatric hemodialysis population. Pediatr. Nephrol. 19, 655–661 (2004).
Parekh, R. S., Carroll, C. E., Wolfe, R. A. & Port, F. K. Cardiovascular mortality in children and young adults with end-stage kidney disease. J. Pediatr. 141, 191–197 (2002).
Oh, J. et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106, 100–105 (2002).
Chavers, B. M. et al. Hypertension in pediatric long-term hemodialysis patients in the United States. Clin. J. Am. Soc. Nephrol. 4, 1363–1369 (2009).
Mitsnefes, M. & Stablein, D. Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am. J. Kidney Dis. 45, 309–315 (2005).
Wühl, E. et al. Strict blood-pressure control and progression of renal failure in children. N. Engl. J. Med. 361, 1639–1650 (2009).
Briese, S. et al. Arterial and cardiac disease in young adults with childhood-onset end-stage renal disease—impact of calcium and vitamin D therapy. Nephrol. Dial. Transplant. 21, 1906–1914 (2006).
KDOQI Work Group. KDOQI Clinical Practice Guideline for Nutrition in Children with CKD: 2008 update. Executive summary. Am. J. Kidney Dis. 53 (Suppl. 2), S11–S104 (2009).
Wong, C. S. et al. Anthropometric measures and risk of death in children with end-stage renal disease. Am. J. Kidney Dis. 36, 811–819 (2000).
Grupe, W. E., Harmon, W. E. & Spinozzi, N. S. Protein and energy requirements in children receiving chronic hemodialysis. Kidney Int. Suppl. 15, S6–S10 (1983).
Krause, I. et al. Intradialytic parenteral nutrition in malnourished children treated with hemodialysis. J. Ren. Nutr. 12, 55–59 (2002).
Goldstein, S. L., Baronette, S., Gambrell, T. V., Currier, H. & Brewer, E. D. nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients. Pediatr. Nephrol. 17, 531–534 (2002).
Orellana, P., Juarez-Congelosi, M. & Goldstein, S. L. Intradialytic parenteral nutrition treatment and biochemical marker assessment for malnutrition in adolescent maintenance hemodialysis patients. J. Ren. Nutr. 15, 312–317 (2005).
Juarez-Congelosi, M., Orellana, P. & Goldstein, S. L. Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J. Ren. Nutr. 17, 269–274 (2007).
Brownbridge, G. & Fielding, D. M. Psychosocial adjustment and adherence to dialysis treatment regimes. Pediatr. Nephrol. 8, 744–749 (1994).
Fukunishi, I. & Honda, M. School adjustment of children with end-stage renal disease. Pediatr. Nephrol. 9, 553–557 (1995).
Fukunishi, I. & Kudo, H. Psychiatric problems of pediatric end-stage renal failure. Gen. Hosp. Psychiatry 17, 32–36 (1995).
Brownbridge, G. & Fielding, D. M. Psychosocial adjustment to end-stage renal failure: comparing haemodialysis, continuous ambulatory peritoneal dialysis and transplantation. Pediatr. Nephrol. 5, 612–616 (1991).
Rosenkranz, J. et al. Psychosocial adaptation of children and adolescents with chronic renal failure. Pediatr. Nephrol. 6, 459–463 (1992).
Gerson, A. C. et al. Assessing health status and health care utilization in adolescents with chronic kidney disease. J. Am. Soc. Nephrol. 16, 1427–1432 (2005).
Gerson, A. et al. Anemia and health-related quality of life in adolescents with chronic kidney disease. Am. J. Kidney Dis. 44, 1017–1023 (2004).
Goldstein, S. L. et al. Health-related quality of life in pediatric patients with ESRD. Pediatr. Nephrol. 21, 846–850 (2006).
Goldstein, S. L. et al. Measuring health-related quality of life in children with ESRD: performance of the generic and ESRD-specific instrument of the Pediatric Quality of Life Inventory (PedsQL). Am. J. Kidney Dis. 51, 285–297 (2008).
Pattaragarn, A., Warady, B. A. & Sabath, R. J. Exercise capacity in pediatric patients with end-stage renal disease. Perit. Dial. Int. 24, 274–280 (2004).
McKenna, A. M. et al. Quality of life in children with chronic kidney disease—patient and caregiver assessments. Nephrol. Dial. Transplant. 21, 1899–1905 (2006).
Goldstein, S. L. et al. Pediatric end stage renal disease health-related quality of life differs by modality: a PedsQL ESRD analysis. Pediatr. Nephrol. 24, 1553–1560 (2009).
Chavers, B. M., Li, S., Collins, A. J. & Herzog, C. A. Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int. 62, 648–653 (2002).
Groothoff, J. W. et al. Mortality and causes of death of end-stage renal disease in children: a Dutch cohort study. Kidney Int. 61, 621–629 (2002).
Furth, S. L. et al. Growth failure, risk of hospitalization and death for children with end-stage renal disease. Pediatr. Nephrol. 17, 450–455 (2002).
Wong, C. S. et al. Hypoalbuminemia and risk of death in pediatric patients with end-stage renal disease. Kidney Int. 61, 630–637 (2002).
Neu, A. M. et al. Growth in adolescent hemodialysis patients: data from the Centers for Medicare & Medicaid Services ESRD Clinical Performance Measures Project. Pediatr. Nephrol. 20, 1156–1160 (2005).
Fadrowski, J. J. et al. Impact of specialization of primary nephrologist on the care of pediatric hemodialysis patients. Am. J. Kidney Dis. 47, 115–121 (2006).
Oosterlee, A. & Rahmel, A. (eds) Annual Report 2008. Eurotransplant International Foundation [online], (2009).
Oh, J. et al. Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106, 100–105 (2002).
Eknoyan, G. et al. Effect of dialysis dose and membrane flux in maintenance hemodialysis. N. Engl. J. Med. 347, 2010–2019 (2002).
Paniagua, R. et al. for the Mexican Nephrology Collaborative Study Group. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J. Am. Soc. Nephrol. 13, 1307–1320 (2002).
Pierratos, A. New approaches to hemodialysis. Ann. Rev. Med. 55, 179–189 (2004).
Chan, C. T. Correspondence: Re: Nocturnal home hemodialysis and salt restriction. Semin. Dial. 17, 321–322 (2004).
Nessim, S. J., Jassal, S. V., Fung, S. V. & Chan, C. T. Conversion from conventional to nocturnal hemodialysis improves vitamin D levels. Kidney Int. 71, 1172–1176 (2007).
Chan, C. T., Floras, J. S., Miller, J. A., Richardson, R. M. & Pierratos, A. Regression of left ventricular hypertrophy after conversion to nocturnal hemodialysis. Kidney Int. 61, 2235–2239 (2002).
Chan, C., Floras, J. S., Miller, J. A. & Pierratos, A. Improvement in ejection fraction by nocturnal haemodialysis in end-stage renal failure patients with coexisting heart failure. Nephrol. Dial. Transplant. 17, 1518–1521 (2002).
Chan, C. T. et al. Impact of nocturnal hemodialysis on the variability of heart rate and duration of hypoxemia during sleep. Kidney Int. 65, 661–665 (2004).
Chan, C. T., Li, S. H. & Verma, S. Nocturnal hemodialysis is associated with restoration of impaired endothelial progenitor cell biology in end-stage renal disease. Am. J. Physiol. Renal Physiol. 289, F679–F684 (2005).
Geary, D. F. et al. Development of a nocturnal home hemodialysis (NHHD) program for children. Semin. Dial. 17, 115–117 (2004).
Müller, D. et al. Intensified hemodialysis regimens: neglected treatment options for children and adolescents. Pediatr. Nephrol. 23, 1729–1736 (2008).
Geary, D. F. et al. Home nocturnal hemodialysis in children. J. Pediatr. 147, 383–387 (2005).
Fischbach, M. et al. Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol. Dial. Transplant. 25, 867–873 (2009).
Fischbach, M., Dheu, C., Seuge, L., Menouer, S. & Terzic, J. In-center daily on-line hemodiafiltration: a 4-year experience in children. Clin. Nephrol. 69, 279–284 (2008).
Hoppe, A. et al. A hospital-based intermittent nocturnal hemodialysis program for children and adolescents. J. Pediatr. 158, 95–99 (2011).
Agar, J. W. Nocturnal haemodialysis in Australia and New Zealand. Nephrology (Carlton) 10, 222–230 (2005).
Galland, R. et al. Short daily hemodialysis rapidly improves nutritional status in hemodialysis patients. Kidney Int. 60, 1555–1560 (2001).
Halpern, S. D., Berns, J. S. & Israni, A. K. Willingness of patients to switch from conventional to daily hemodialysis: looking before we leap. Am. J. Med. 116, 606–612 (2004).
Lindsay, R. M., Heidenheim, P. A., Nesrallah, G., Garg, A. X. & Suri, R. for the Daily Hemodialysis Study Group London Health Sciences Centre. Minutes to recovery after a hemodialysis session: a simple health-related quality of life question that is reliable, valid, and sensitive to change. Clin. J. Am. Soc. Nephrol. 1, 952–959 (2006).
Kooistra, M. P., Vos, J., Koomans, H. A. & Vos, P. F. Daily home haemodialysis in The Netherlands: effects on metabolic control, haemodynamics, and quality of life. Nephrol. Dial. Transplant. 13, 2853–2860 (1998).
Mohr, P. E. et al. The case for daily dialysis: its impact on costs and quality of life. Am. J. Kidney Dis. 37, 777–789 (2001).
Reynolds, J. T. et al. A one-year trial of in-center daily hemodialysis with an emphasis on quality of life. Blood Purif. 22, 320–328 (2004).
Ting, G. O., Kjellstrand, C., Freitas, T., Carrie, B. J. & Zarghamee, S. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am. J. Kidney Dis. 42, 1020–1035 (2003).
Nesrallah, G. E. et al. The International Quotidian Dialysis Registry: annual report 2007. Hemodial. Int. 11, 271–277 (2007).
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D. Müller and S. L. Goldstein contributed equally to discussion of content for the article, researching data to include in the manuscript and reviewing and editing of the manuscript before submission.
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Müller, D., Goldstein, S. Hemodialysis in children with end-stage renal disease. Nat Rev Nephrol 7, 650–658 (2011). https://doi.org/10.1038/nrneph.2011.124
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DOI: https://doi.org/10.1038/nrneph.2011.124
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