Dialysis in Children

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Dialysis in Children

  1. 1. Dialysis in Children Jessica Hoff Childhood Nutrition
  2. 2. Renal Disease <ul><li>Not common in children </li></ul><ul><li>Not many facilities to accommodate pediatric renal cases </li></ul><ul><li>Only in OKC for Oklahoma, no pediatric nephrologists in Tulsa </li></ul><ul><li>Difficult diagnosis for any age, but especially children </li></ul>
  3. 3. Renal Disease <ul><li>Acute Renal Failure (ARF) -glomerulomephritis -acute tubular necrosis -lupus </li></ul><ul><li>Chronic Renal Failure (CRF) -renal malformations -hydronephrosis </li></ul><ul><li>Hemolytic-uremic syndrome </li></ul>
  4. 4. Treatment <ul><li>Dialysis -Peritoneal Dialysis -Hemodialysis </li></ul><ul><li>Dialysis intiated if BUN reaching 150mg/dl, CHF, HTN, hyperkalemia, etc. </li></ul><ul><li>Maintenance dialysis should be intiated when creatinine clearance < 5 ml/min </li></ul><ul><li>Transplant (best option) </li></ul>
  5. 5. Peritoneal Dialysis <ul><li>Most common </li></ul><ul><li>Done at home </li></ul><ul><li>Many advantages (freedom, etc.) </li></ul><ul><li>Catheter placed in peritoneal cavity </li></ul><ul><li>CAPD - Continuous Ambulatory Peritoneal Dialysis </li></ul><ul><li>APD - Automated Peritoneal Dialysis </li></ul>
  6. 6. PD Complications <ul><li>Peritonitis </li></ul><ul><li>Mostly caused by poor hygeine, sanitation conditions when performing exchanges </li></ul><ul><li>Research Study - peritonitis & catheter infections increase with time on PD; pts with cath infec 2x likely for peritonitis, 3x likely to be hospitalized </li></ul>
  7. 7. PD Complications <ul><li>Pericatheter leak </li></ul><ul><li>Outflow failure </li></ul><ul><li>Hypovolemia or Hypervolemia </li></ul><ul><li>Hernias </li></ul>
  8. 8. Hemodialysis <ul><li>Not as common </li></ul><ul><li>Has to be done in special unit </li></ul><ul><li>Uses a dialysis machine to cleanse blood and recirculate into body </li></ul><ul><li>3 different accesses: fistula, graft, or catheter </li></ul><ul><li>Children most often use catheters due to small blood vessels </li></ul>
  9. 9. HD Complications <ul><li>Access problems -clotting -infection </li></ul><ul><li>Leg cramps </li></ul><ul><li>Nausea, vomiting </li></ul><ul><li>Headache </li></ul>
  10. 10. Nutritional Needs <ul><li>Very important for children due to increased growth and development </li></ul><ul><li>Poor appetite, anorexia </li></ul><ul><li>Have to think of ways to get children to eat </li></ul><ul><li>May require supplements or TF (special formulas available for renal pts) </li></ul>
  11. 11. Nutritional Needs <ul><li>Nutritional needs depend on stage of disease, tx type, age </li></ul><ul><li>Energy needs about the same </li></ul><ul><li>Increased protein needs </li></ul><ul><li>Fluid depends on renal function, may need fluid restriction </li></ul><ul><li>Need to restrict intake of K, P, Na </li></ul>
  12. 12. Growth <ul><li>Big issue, big concern </li></ul><ul><li>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 </li></ul>
  13. 13. Growth <ul><li>Growth hormone use </li></ul><ul><li>Work best pre-ESRD kids, have been shown to work somewhat in dialysis pts </li></ul><ul><li>Research study - growth hormone tx  bone density axial skeleton, not body as whole; lean body mass  , % body fat  ; growth rate sig  </li></ul>
  14. 14. Pediatric Nephrology Team <ul><li>Family </li></ul><ul><li>Pediatric nephrologist </li></ul><ul><li>RN </li></ul><ul><li>RD </li></ul><ul><li>Social Worker </li></ul><ul><li>Child psychologist </li></ul>
  15. 15. References <ul><li>Daugirdas JT, Ing TS. Handbook of dialysis. Boston: Little, Brown, and </li></ul><ul><li>Company; 1988. </li></ul><ul><li>Furth SL, Donaldson LA, Sullivan EK, Watkins SL. Peritoneal dialysis catheter </li></ul><ul><ul><ul><li>infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1999;15:179-182. </li></ul></ul></ul><ul><li>Furth SL, Stablein D, Fine RN, Powe NR, Fivush BA. Adverse clinical outcomes </li></ul><ul><ul><ul><li>associated with short stature as dialysis initiation: a report of the North American pediatric renal transplant cooperative study. 2002;109:909-914. </li></ul></ul></ul><ul><li>Levine DZ. Caring for the renal patient. 3 rd ed. Philadelphia: W.B. Saunders </li></ul><ul><li>Company; 1997. </li></ul><ul><li>McCann L. Nutrition in end stage renal disease. The Exceptional Parent. </li></ul><ul><li>1999;29:71-72 </li></ul><ul><li>Orsini J. Comprehensive care for children with renal disease. The Exceptional </li></ul><ul><li>Parent. 1999;29:36-38. </li></ul><ul><li>Smith T, editor. Renal Nursing. London: Bailliere Tindall; 1997. </li></ul><ul><li>van der Sluis IM, Boot AM, Nauta J, Hop WCJ, de Jong MCJW, Lilien MR, </li></ul><ul><ul><ul><li>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. </li></ul></ul></ul><ul><li>Warady BA, Fivush BA. Dialysis therapy for patients with chronic kidney failure. </li></ul><ul><li>The Exceptional Parent. 1999;29:34-36. </li></ul><ul><li>Wilkens KG, Schiro KB. Suggested guidelines for nutrition care of renal patients. </li></ul><ul><li>Chicago: The American Dietetic Association; 1992.zx </li></ul>

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