Review Article | Published:

Hemodialysis in children with end-stage renal disease

Nature Reviews Nephrology volume 7, pages 650658 (2011) | Download Citation

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

  • The incidence and prevalence of pediatric patients with end-stage renal disease receiving maintenance hemodialysis have increased over the past decade

  • Considerations regarding vascular access include the size of the patient's vessels, surgical expertise and expected time on hemodialysis before transplantation

  • Aggressive monitoring of nutrition and supplementation is required to optimize growth and development in children receiving hemodialysis

  • Intensified hemodialysis regimens might result in improved outcomes

  • 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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Affiliations

  1. Department of Pediatric Nephrology, Charité University Hospital, Augustenburger Platz 1, 13353 Berlin, Germany

    • Dominik Müller
  2. Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, MLC 7022, 3333 Burnet Avenue, Cincinnati, OH 45229, USA

    • Stuart L. Goldstein

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Contributions

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.

Competing interests

The authors declare no competing financial interests.

Corresponding author

Correspondence to Stuart L. Goldstein.

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DOI

https://doi.org/10.1038/nrneph.2011.124

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