Children with end-stage-renal-disease (ESRD) differ from adults in the etiology of renal failure. The goals of management are also different. This is particularly true in regards to growth failure, a problem that is unique to the pediatric population. This study, which was conducted in 1996, provides a cross-sectional view of the management of children with ESRD in Texas. It serves as a point-of-comparison for future changes in management practice. Data collected on 94 children with ESRD managed in six pediatric facilities and 18 adult dialysis facilities in Texas revealed that a greater proportion of younger pediatric patients received peritoneal dialysis (PD). Patients on PD had a significantly lower serum albumin level than those on hemodialysis. Hemodialysis (HD) and PD patients were 2.3 and 1.7 standard deviation scores (SDS) below the average height of the age- and gender-matched populations respectively. There was no significant difference in hematocrit, use of growth hormone, parathyroid hormone level, weight SDS, or bone age by treatment modality. However, patients dialyzed in pediatric facilities were more likely to receive growth hormone and to be regularly evaluated for Tanner stage and bone age than those in adult facilities. Measurement of creatinine clearance as a measure of the adequacy of PD in young children was not a common practice. Instead, pediatric nephrologists tended to rely more on anthropometric measurements, developmental maturation, and serum albumin to assess adequacy. Opportunities remain to maximize the growth potential and to develop standards for the adequacy of dialysis in the younger pediatric patient.
Learning Objectives: Develop a care plan for pediatric end-stage-renal-disease patients who require specialized pediatric nephrologic care to ensure dialysis adequacy, anemia and nutritional support, and physical growth
Keywords: Children With Special Needs, Chronic Diseases
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: End-Stage-Renal-Disease Network of Texas, Inc
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.