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Dialysis in Children

Dialysis in Children

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Dialysis in Children

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  1. Dialysis in Children Jessica Hoff Childhood Nutrition

  2. Renal Disease • Not common in children • Not many facilities to accommodate pediatric renal cases • Only in OKC for Oklahoma, no pediatric nephrologists in Tulsa • Difficult diagnosis for any age, but especially children

  3. Renal Disease • Acute Renal Failure (ARF)-glomerulomephritis-acute tubular necrosis-lupus • Chronic Renal Failure (CRF)-renal malformations-hydronephrosis • Hemolytic-uremic syndrome

  4. Treatment • Dialysis-Peritoneal Dialysis-Hemodialysis • Dialysis intiated if BUN reaching 150mg/dl, CHF, HTN, hyperkalemia, etc. • Maintenance dialysis should be intiated when creatinine clearance <5 ml/min • Transplant (best option)

  5. Peritoneal Dialysis • Most common • Done at home • Many advantages (freedom, etc.) • Catheter placed in peritoneal cavity • CAPD - Continuous Ambulatory Peritoneal Dialysis • APD - Automated Peritoneal Dialysis

  6. PD Complications • Peritonitis • Mostly caused by poor hygeine, sanitation conditions when performing exchanges • Research Study - peritonitis & catheter infections increase with time on PD; pts with cath infec 2x likely for peritonitis, 3x likely to be hospitalized

  7. PD Complications • Pericatheter leak • Outflow failure • Hypovolemia or Hypervolemia • Hernias

  8. Hemodialysis • Not as common • Has to be done in special unit • Uses a dialysis machine to cleanse blood and recirculate into body • 3 different accesses: fistula, graft, or catheter • Children most often use catheters due to small blood vessels

  9. HD Complications • Access problems-clotting-infection • Leg cramps • Nausea, vomiting • Headache

  10. Nutritional Needs • Very important for children due to increased growth and development • Poor appetite, anorexia • Have to think of ways to get children to eat • May require supplements or TF (special formulas available for renal pts)

  11. Nutritional Needs • Nutritional needs depend on stage of disease, tx type, age • Energy needs about the same • Increased protein needs • Fluid depends on renal function, may need fluid restriction • Need to restrict intake of K, P, Na

  12. Growth • Big issue, big concern • Research study - (short stature beginning of dialysis) found kids with short stature had sig more hospitalizations than other kids on dialysis; need proper aggressive nutritional tx for pre-ESRD kids

  13. Growth • Growth hormone use • Work best pre-ESRD kids, have been shown to work somewhat in dialysis pts • Research study - growth hormone tx  bone density axial skeleton, not body as whole; lean body mass , % body fat ; growth rate sig 

  14. Pediatric Nephrology Team • Family • Pediatric nephrologist • RN • RD • Social Worker • Child psychologist

  15. References • Daugirdas JT, Ing TS. Handbook of dialysis. Boston: Little, Brown, and • Company; 1988. • Furth SL, Donaldson LA, Sullivan EK, Watkins SL. Peritoneal dialysis catheter • infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1999;15:179-182. • Furth SL, Stablein D, Fine RN, Powe NR, Fivush BA. Adverse clinical outcomes • associated with short stature as dialysis initiation: a report of the North American pediatric renal transplant cooperative study. 2002;109:909-914. • Levine DZ. Caring for the renal patient. 3rd ed. Philadelphia: W.B. Saunders • Company; 1997. • McCann L. Nutrition in end stage renal disease. The Exceptional Parent. • 1999;29:71-72 • Orsini J. Comprehensive care for children with renal disease. The Exceptional • Parent. 1999;29:36-38. • Smith T, editor. Renal Nursing. London: Bailliere Tindall; 1997. • van der Sluis IM, Boot AM, Nauta J, Hop WCJ, de Jong MCJW, Lilien MR, • Groothoff JW, van Wijk AE, Pols HAP, Hokken-Koelega ACS, de Munick Keizer-Schrama SMPF. Bone density and body composition in chronic renal failure: effects of growth hormone treatment. Pedatr Nephrol. 2000;15:221-228. • Warady BA, Fivush BA. Dialysis therapy for patients with chronic kidney failure. • The Exceptional Parent. 1999;29:34-36. • Wilkens KG, Schiro KB. Suggested guidelines for nutrition care of renal patients. • Chicago: The American Dietetic Association; 1992.zx