Issues in Pediatric Dialysis

CHILDREN, in increasing numbers , require long-term dialysi s due to the lack of availability of suitable kidneys for tran splantation, the development of high titers of cytotoxic antibodies, the loss of a functioning allograft, and the need in infants for an increase in body size. The availability in the past decade of automatic cyclers and the development of continuous ambulatory peritoneal dialysis (CAPD) followed by continuous cyclic peritoneal dialysis (CCPD) have resulted in peritoneal dialysis being offered to a greater fraction of children with end-stage renal disease. Peritoneal dialysis, with rare exception, is the modality used for chronic dialysis in neonates . Even though most advances in pediatric dialysis during the past 5 years have occurred in the area of peritoneal dialysis, improvements in pediatric hemodialysis continue. Despite significant advances in dialytic care for children with end-stage renal disease , long-term data comparing various forms of dialysis from single centers are sparse. Considered in this report are data comparing CAPD with hemodialysis and intermittent peritoneal dialysis (IPD) with CAPD. A long-term experience with CAPD in neonates and single-center experience with continuous forms of peritoneal dialysis (CPD) also will be reviewed. Finally, the role of urea kinetic modeling in pediatric hemodialysis will be considered .