1. Dialysis in Children Jessica Hoff Childhood Nutrition

2. Renal Disease zNot common in children zNot many facilities to accommodate pediatric renal cases zOnly in OKC for Oklahoma, no pediatric nephrologists in Tulsa zDifficult diagnosis for any age, but especially children

3. Renal Disease zAcute Renal Failure (ARF) -glomerulomephritis -acute tubular necrosis -lupus zChronic Renal Failure (CRF) -renal malformations -hydronephrosis zHemolytic-uremic syndrome

4. Treatment zDialysis -Peritoneal Dialysis -Hemodialysis zDialysis intiated if BUN reaching 150mg/dl, CHF, HTN, hyperkalemia, etc. zMaintenance dialysis should be intiated when creatinine clearance <5 ml/min zTransplant (best option)

5. Peritoneal Dialysis zMost common zDone at home zMany advantages (freedom, etc.) zCatheter placed in peritoneal cavity zCAPD - Continuous Ambulatory Peritoneal Dialysis zAPD - Automated Peritoneal Dialysis

6. PD Complications zPeritonitis zMostly caused by poor hygeine, sanitation conditions when performing exchanges zResearch 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 zPericatheter leak zOutflow failure zHypovolemia or Hypervolemia zHernias

8. Hemodialysis zNot as common zHas to be done in special unit zUses a dialysis machine to cleanse blood and recirculate into body z3 different accesses: fistula, graft, or catheter zChildren most often use catheters due to small blood vessels

9. HD Complications zAccess problems -clotting -infection zLeg cramps zNausea, vomiting zHeadache

10. Nutritional Needs zVery important for children due to increased growth and development zPoor appetite, anorexia zHave to think of ways to get children to eat zMay require supplements or TF (special formulas available for renal pts)

11. Nutritional Needs zNutritional needs depend on stage of disease, tx type, age zEnergy needs about the same zIncreased protein needs zFluid depends on renal function, may need fluid restriction zNeed to restrict intake of K, P, Na

12. Growth zBig issue, big concern zResearch 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 zGrowth hormone use zWork best pre-ESRD kids, have been shown to work somewhat in dialysis pts zResearch study - growth hormone tx  bone density axial skeleton, not body as whole; lean body mass , % body fat  ; growth rate sig 

14. Pediatric Nephrology Team zFamily zPediatric nephrologist zRN zRD zSocial Worker zChild psychologist

15. References zDaugirdas JT, Ing TS. Handbook of dialysis. Boston: Little, Brown, and zCompany; 1988. zFurth SL, Donaldson LA, Sullivan EK, Watkins SL. Peritoneal dialysis catheter xinfections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol. 1999;15:179-182. zFurth SL, Stablein D, Fine RN, Powe NR, Fivush BA. Adverse clinical outcomes xassociated with short stature as dialysis initiation: a report of the North American pediatric renal transplant cooperative study. 2002;109:909-914. zLevine DZ. Caring for the renal patient. 3 rd ed. Philadelphia: W.B. Saunders zCompany; 1997. zMcCann L. Nutrition in end stage renal disease. The Exceptional Parent. z1999;29:71-72 zOrsini J. Comprehensive care for children with renal disease. The Exceptional zParent. 1999;29:36-38. zSmith T, editor. Renal Nursing. London: Bailliere Tindall; 1997. zvan der Sluis IM, Boot AM, Nauta J, Hop WCJ, de Jong MCJW, Lilien MR, xGroothoff 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. zWarady BA, Fivush BA. Dialysis therapy for patients with chronic kidney failure. zThe Exceptional Parent. 1999;29:34-36. zWilkens KG, Schiro KB. Suggested guidelines for nutrition care of renal patients. zChicago: The American Dietetic Association; 1992.zx