Educational Review

Pediatric Nephrology

, Volume 24, Issue 7, pp 1287-1295

Open Access This content is freely available online to anyone, anywhere at any time.

Clinical outcomes in pediatric hemodialysis patients in the USA: lessons from CMS’ ESRD CPM Project

  • Alicia M. NeuAffiliated withDivision of Pediatric Nephrology, Johns Hopkins Medicine Email author 
  • , Diane L. FrankenfieldAffiliated withOffice of Research, Development and Information, The Centers for Medicare & Medicaid Services (CMS)

Abstract

Although prospective randomized trials have provided important information and allowed the development of evidence-based guidelines in adult hemodialysis (HD) patients, with approximately 800 prevalent pediatric HD patients in the United States, such studies are difficult to perform in this population. Observational data obtained through the Center for Medicare & Medicaid Services’ (CMS’) End Stage Renal Disease (ESRD) Clinical Performance Measures (CPM) Project have allowed description of the clinical care provided to pediatric HD patients as well as identification of risk factors for failure to reach adult targets for clinical parameters such as hemoglobin, single-pool Kt/V (spKt/V) and serum albumin. In addition, studies linking data from the ESRD CPM Project and the United States Renal Data System have allowed evaluation of associations between achievement of those targets and the outcomes of hospitalization and death. The results of those studies, while unable to prove cause and effect, suggest that the adult ESRD CPM targets may assist in identifying pediatric HD patients at risk for poor outcomes.

Keywords

Pediatric Hemodialysis Outcomes Clinical performance measures CPM Hospitalization Mortality