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End-stage kidney disease in infancy: an educational review

Abstract

An increasing number of infants with end-stage kidney disease (ESKD) are surviving and receiving renal replacement therapy (RRT). Unique clinical issues specific to this age group of patients influence their short- and long-term outcomes. This review summarizes current epidemiology, clinical characteristics, ethical dilemmas, management concerns, and outcomes of infants requiring chronic dialysis therapy. Optimal care during infancy requires a multidisciplinary team working closely with the patient’s family. Nutritional management, infection prevention, and attention to cardiovascular status are important treatment targets. Although mortality rates remain higher among infants on dialysis compared to older pediatric dialysis patients, outcomes have improved over time. Most importantly, infants who subsequently receive a kidney transplant are now experiencing graft survival rates that are comparable to older pediatric patients.

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Fig. 1

Abbreviations

ESKD:

End-stage kidney disease

CPD:

Chronic peritoneal dialysis

HD:

Hemodialysis

RRT:

Renal replacement therapy

NAPRTCS:

North American Pediatric Renal Trials and Collaborative Studies

ANZDATA:

Australia and New Zealand Dialysis and Transplant Registry

KDOQI:

Kidney Disease Outcomes Quality Initiative

IPPN:

International Pediatric Peritoneal Dialysis Network

USRDS:

United States Renal Data System

EPDWG:

European Pediatric Dialysis Working Group

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Funding source

The primary author is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant KL2TR001109. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Correspondence to Keia R. Sanderson.

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Answers: 1.d, 2.c, 3.e, 4.c

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Sanderson, K.R., Warady, B.A. End-stage kidney disease in infancy: an educational review. Pediatr Nephrol 35, 229–240 (2020). https://doi.org/10.1007/s00467-018-4151-8

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Keywords

  • Peritoneal dialysis
  • Hemodialysis
  • Chronic peritoneal dialysis
  • Chronic hemodialysis
  • Pediatric ESKD
  • Infants
  • Neonates
  • Growth
  • Nutrition