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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. 3 rd 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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