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Dialysis in Children

Dialysis in Children. Jessica Hoff Childhood Nutrition. 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. Renal Disease.

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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

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