Maintenance dialysis in North American children and adolescents: A preliminary report

Alexander, Steven R.; Sullivan, E. Kenneth; Harmon, William E.; Stablein, Donald M.; Tejani, Amir
October 1993
Kidney International Supplement;Oct1993, Issue 43, pS104
Academic Journal
During 1992 the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) began to develop a pediatric Dialysis Patient Data Base by collecting data on pediatric patients who had received either hemodialysis (HD) or peritoneal dialysis (PD), or both, at a participating NAPRTCS center. This preliminary report describes study methods and contains detailed, though short-term observations reported by 64 of 87 NAPRTCS centers on 762 patients who were <21 years of age at enrollment and who received treatment between January 1, 1992 and September 15, 1992. In these 762 patients, a total of 810 independent courses of dialysis therapy were identified (PD = 534 [65.9%]; HD = 276 [34.1%]). Patient age groupings showed a significantly greater proportion of PD patients among younger age groups. Automated peritoneal dialysis was used by about 75% of registered PD patients at one and six months after registration. A total of 196 peritonitis episodes were reported, yielding a peritonitis rate of one episode every 7.1 patient-months. Ten percent of PD catheters were replaced, primarily for mechanical malfunction and leaks. Percutancous catheters were used for vascular access in about one-half of the HD patients, with the remainder almost equally divided between arteriovenous fistulae and grafts. Vascular access revision was reported in 28% of HD patients, with about one-third of these revisions performed to create a more permanent access. Recombinant human erythropoietin therapy was used in 89% of PD and 94% of HD patients at six months. Recombinant human growth hormone therapy was used in 9% of PD and 5% of HD patients at six months. By six months, 36.9% of patients were on cadaver transplantation waiting lists, with transplant recipient workups underway in an additional 21.9% of patients. Of the 40.5% of patients reported not to be actively pursuing transplantation, 50% cited medical problems and 50% cited patient/family preference as reasons. Nine patients died and 44 changed from one dialysis modality to the other. Infection complications predominated among PD patients who changed to HD, while psychosocial issues were more frequently cited reasons for HD patients to change to PD. The present report is preliminary and intended to be primarily descriptive. Future reports will examine in depth those issues introduced by the data presented in this report.


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