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Treatment options for children with End Stage Renal Failure

Treatment options for children with End Stage Renal Failure. David V Milford Birmingham Children’s Hospital. Regional context. Renal Unit established by Mike Winterbon October 1979 288 children treated for ESRF to date. Age at start of RRT Birmingham Children’s Hospital. age. 20. died.

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Treatment options for children with End Stage Renal Failure

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  1. Treatment options for children with End Stage Renal Failure David V Milford Birmingham Children’s Hospital

  2. Regional context Renal Unit established by Mike Winterbon October 1979 288 children treated for ESRF to date

  3. Age at start of RRT Birmingham Children’s Hospital age 20 died 15 10 5 0 1980 1982 1984 1986 1988 1990 1992

  4. Peritoneal dialysis • CCPD>CAPD • Advantages • nocturnal therapy (CCPD) • relative preservation of daily routine • easy(ish) to learn • Disadvantages • less efficient than HD • requires strict attention to technique • pressure on carers • infections are (relatively) common • not possible in some patients

  5. Haemodialysis • Hospital HD, home HD • Advantages • less pressure on carers • efficient, requires less time • frequent hospital reviews • Disadvantages • disruptive of routine • access problems • hospital dependant • requires special equipment,fluids

  6. Kidney transplantation • Cadavaric, live donor • Before/after dialysis • Advantages • restores normal renal functions • improved growth, development, educational progress • Disadvantages • lifelong immunosuppression (infections, neoplasia) • sensitisation • graft loss

  7. Pre-emptive renal transplantation transplantation prior to dialysis LRD or CAD kidneys Advantages avoids stress of dialysis better for growth and development Disadvantages timing is difficult for CAD risk of transplanting unnecessarily

  8. Transplantation • Developments • better immunosuppressive regimens • less nephrotoxic immunosuppressive drugs • less steroids • reduced incidence of rejection • improved graft survival • acceptance of pre-emptive grafting • improved bladder management • ABO and HLA incompatible grafts

  9. 1 year graft survival (UNOS) LRD cadavaric Hariharan et al NEJM 2000; 342:605-12

  10. Birmingham Children’s Hospital Kaplan Meier Actuarial Survival Curve (excluding deaths with a functioning graft) n=80 Graft Survival (days) 1.0 0.8 0.6 Cumulative Survival 0.4 0.2 0.0 0.00 1000.00 2000.00 3000.00 4000.00 5000.00 Graft survival (days)

  11. Transplantation • Limitations • inadequate supply of cadavaric organs • compliance issues

  12. Transplant numbers

  13. Patients on Waiting list 2000- Dec 2006

  14. Transplant losses >3 months after Tx 1.1.1995-31.12.2004

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