Pediatric Dialysis

Preface
Acknowledgments
Contents
Contributors
Part I: Essential Primers
	1: Notes on the History of Dialysis Therapy in Children
		Introduction
		Peritoneal Dialysis
		Hemodialysis
		Patient Registries and Multicenter Studies
		Conclusion
		References
	2: The Biology of Dialysis
		Introduction
		Biology of Uremic Toxicity
		Solute Removal Mechanisms in Extracorporeal Dialysis
			Diffusion
			Solute Removal by Convection
			Solute Removal by Internal Filtration
			New Membrane Designs for Enhanced Removal of Large Toxins
			Solute Removal by Adsorption
			Peritoneal Dialysis: Biologic and Mass Transfer Considerations
			Factors Affecting Solute Transport
			Relationship Between Clearance and Mass Removal Rate Among Various Renal Replacement Therapies
		Clearance as a Dialyzer Performance Parameter
			Whole-Blood Clearance
			Blood Water and Plasma Clearance
			Dialysate-Side Clearance
			Whole-Body Clearance
		References
	3: The Demographics of Dialysis in Children
		Introduction
		Sources of Demographic Data on Pediatric Dialysis Patients
		Incidence and Prevalence
			Access to Dialysis Around the World
			Effect of Era on the Incidence and Prevalence of ESKD in Children
			Effect of Age on the Incidence of RRT and Treatment Modality
		Primary Kidney Disease Diagnosis
		Mortality Risk
		Conclusion
		References
	4: Chronic Dialysis in Developing Countries
		Introduction
		Economic Indicators
		Epidemiology of Renal Replacement Therapy in Developing Countries
		Demographics of the ESRD Population in Developing Countries
		Challenges Faced by Developing Countries in the Provision of Pediatric RRT
		Conclusion
		References
	5: Organization and Management of a Pediatric Dialysis Program
		Introduction
		Operational Management
			Facility Culture and Organization
			Physical Space Needs
			Staffing the Unit
			Billing and Regulatory Guidelines
		Care Implementation
			Modality Selection
			Patient/Family Education
			Patient Care Plans
			Patient and Family Support
			Transition and Transfer of Care
			Quality Improvement and Safety
		Oversight and Ongoing Operations
		Conclusion
		References
	6: Role of the Advanced Practice Provider in a Pediatric Dialysis Program
		Introduction
		History of the Advanced Practice Provider (APP)
			Nurse Practitioner
			Physician Assistant
		Orientation for the APP
		The APP in the Dialysis Unit
			Role of the APP in Hemodialysis
			Role of the APP in Peritoneal Dialysis
			Role of the APP in Critical Care Nephrology
		Billing Practices for the APP
		The Role of the APP in Transitions of Care
			CKD-ESKD
			Dialysis to Transplant
			Pediatric to Adult Care
		The Role of the APP in Improving Patient Outcomes
		Conclusion
		References
	7: Quality Improvement Strategies and Outcomes in Pediatric Dialysis
		Introduction
		Clinical Practice Guidelines and Clinical Performance Measures
		Oversight of Centers for Medicaid and Medicare (CMS) and State Regulations
		Quality Assessment and Performance Improvement Program
		Networks
		The ESRD Quality Incentive Program of the USA
		Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb)
		National Healthcare Safety Network (NHSN)
		Dialysis Facility Report (DFR)
		Dialysis Facility Compare
		Developing a Quality Assessment Performance Improvement (QAPI) Program
		Challenges for the Small Pediatric Program
		Quality Improvement Design
		What Is the Problem?
		Quality Improvement Methodology
		What Are We Trying to Accomplish?
		How Will We Know a Change Is an Improvement?
		What Changes Can We Make That Will Result in Improvement?
		Plan
		Do
		Study
		Act
		Sustainability
		Conclusion
		References
	8: Antibiotic Stewardship in the Pediatric Dialysis Unit
		Introduction
		Antibiotic-Resistant Bacterial Infections in Children
		Common Pathogens in Pediatric Dialysis Patients
		Negative Consequences of Antibiotic Use
		Antibiotic Use in Children
		Antibiotic Use in Dialysis Patients
		Antimicrobial Stewardship
		Antimicrobial Stewardship Strategies
			Inpatient
			Outpatient
			Dialysis Specific
		Diagnostics
			Hemodialysis
			Peritoneal Dialysis
		Infection Prevention
		Vaccination
		Summary
		References
Part II: Considerations Around the Initiation of Dialysis
	9: The Decision to Initiate Dialysis in Children and Adolescents
		Introduction
		Methodology for Measuring Kidney Function
		Predialysis Patient Monitoring and Preparation for Dialysis
		Indications for Initiating Dialysis
			Absolute Indications for Initiating Dialysis
			Relative Indications for Initiating Dialysis
				Uremic Symptoms
				Hyperkalemia
				Hyperphosphatemia
				Malnutrition
				Growth Failure
		Timing of Elective Dialysis Initiation
			Estimated GFR at Dialysis Initiation
			Consensus Statements Regarding Dialysis Initiation
			Arguments for Early (“Timely”) Initiation
			Arguments for Delayed Initiation
		Choice of Mode of Dialysis
		References
	10: Urological Issues in Pediatric Dialysis
		Introduction
		Urological Causes of Chronic Kidney Disease
		Posterior Urethral Valves
		Vesicoureteral Reflux in the Pediatric Dialysis Patient
		Neurogenic Voiding Dysfunction
		Bladder Augmentation and End-Stage Kidney Disease
		Prune Belly Syndrome
		Urological Issues in the Pretransplant Workup
		Nephrectomy
		Inguinal Hernias and Peritoneal Dialysis
		Stomas, Catheters, Vascular Access, and Incisions
		Summary
		References
	11: Preservation of Residual Renal Function in Children Reaching End-Stage Renal Disease
		Introduction
		Measurement of RRF
		Clinical Benefits of RRF
		General Risk Factors for Loss of Renal Function
		Specific Risk Factors for Loss of RRF in Patients on Dialysis
		Clinical Management Options to Slow CKD Progression and Preserve RRF on Dialysis
		Avoidance of Risk Factors
		Blood Pressure Control
		RAS Inhibition
		Diuretics
		Peritoneal Dialysis
		Hemodialysis
		Emerging Therapies
		Special Conditions
		References
Part III: Peritoneal Dialysis
	12: Peritoneal Access in Children Receiving Dialysis
		Peritoneal Dialysis Access
		Access Types
		Preoperative Evaluation and Preparation
		Omentectomy
		Fibrin Sealant
		Surgical Technique
		Laparoscopic Technique
		Open Technique
		Postimplantation Care
		Timing of Catheter Use
		Chronic Exit-Site Care
		Mechanical Complications
		Exit-Site Infection, Tunnel Infection, and Peritonitis
		PD Catheter Care Post-Kidney Transplantation
		Complications with PD Catheter Removal
		Conclusion
		References
	13: Technical Aspects and Prescription of Peritoneal Dialysis in Children
		Introduction
		Update on PD Connection Technology
		Catheter-to-Transfer Set Connectors
		Transfer Set-to-Container Connection
		Transfer Sets
		Straight Transfer Set (the Standard Oreopoulos System)
		The Y-Set
		Peritoneal Dialysis Prescription
		The Peritoneal Dialysis System
			Peritoneal Microcirculation
			Peritoneal Membrane
			Dialysis Fluid Compartment
		Driving Forces of Solute and Water Exchange
			Diffusive Transport
			Ultrafiltration
			Convective Mass Transfer
		Peritoneal Membrane Function Tests
		Mass Transfer Area Coefficient
		Peritoneal Equilibration Test
		Standard Permeability Analysis
		Personal Dialysis Capacity Test
		Prescription of Peritoneal Fill Volume
		Prescription of Dwell Time
		Peritoneal Dialysis Methods and Regimens
			Continuous Ambulatory Peritoneal Dialysis (CAPD)
			Automated Peritoneal Dialysis (APD)
			Nightly Intermittent Peritoneal Dialysis (NIPD)
			Continuous Cyclic Peritoneal Dialysis (CCPD)
			Tidal Peritoneal Dialysis (TPD)
		Adapted APD
		Concluding Remarks
		Peritonitis in APD Patients
		Evaluation of the Adequacy of Peritoneal Dialysis Treatment
		Clearance of Small Solutes
		Clearance of Middle-Sized Molecules
		Fluid Balance
		The Role of Residual Renal Function in Treatment Adequacy
		Clinical Evaluation of PD Treatment Adequacy
		Monitoring PD Adequacy in the Clinical Setting
		Machines for Automated Peritoneal Dialysis
			Characteristics of Cyclers for Automated Peritoneal Dialysis
		Registration of Treatment Data
		Transmission of Treatment Data
		Monitoring of Patient Adherence to the Prescribed APD Treatment
		Strategies to Enhance Patient Adherence to PD Prescriptions
		Conclusions
		References
	14: Peritoneal Dialysis Solutions
		Introduction
		Biocompatibility
		PD Solution Components
		Electrolyte Composition
			Calcium
			Magnesium
		Alternate PD Solutions and Membrane-Sparing Strategies
		Conclusion
		References
	15: Peritoneal Dialysis During Infancy
		Introduction
		Incidence and Etiology
		Ethical Considerations: Should Dialysis Be Initiated?
		Peritoneal Dialysis Access
		Prescription
		Nutrition and Growth
		Complications
		Hospitalization and Long-Term Outcomes
		Conclusions
		References
	16: Infectious Complications of Peritoneal Dialysis in Children
		Introduction
		Incidence of PD-Related Infections
		Microbiology of PD-Related Infections
			Peritonitis
			PD Catheter-Related Infections
		Risk Factors and Prevention
			Patient Age
			PD Catheter Design, Insertion, and Postoperative Exit-Site Care
			Training
			Chronic Exit-Site Care
			Touch Contamination
			Ostomies
			Antibiotic and Antifungal Prophylaxis
			Other Factors
		Diagnosis and Management of Peritonitis
			Diagnosis
			Empiric Therapy
			Subsequent Treatment of Peritonitis
				Gram-Positive Peritonitis
				Gram-Negative Peritonitis
				Culture-Negative Peritonitis
				Fungal Peritonitis
				Relapsing Peritonitis
				Refractory Peritonitis
		Diagnosis and Management of PD Catheter-Related Infections
			Diagnosis
			Treatment of PD Catheter-Related Infections
		Outcome
		References
	17: Noninfectious Complications of Peritoneal Dialysis in Children
		Mechanical Complications of PD
			Obstruction of PD Fluid Flow
				Prevention Strategies
				Treatment Options
				Outcome
			Dialysate Leakage
				Risk Factors and Prevention
				Diagnosis
				Management
			Hernia
				Risk Factors
				Clinical Features
				Diagnosis
				Prevention
				Treatment
				Hydrothorax
				Pathogenesis
				Clinical Features
				Diagnosis
				Treatment
		Technique-Related Complications
			Peritoneal Membrane Failure
				Pathogenesis
				Differential Diagnosis
				Management
				Prognosis
			Encapsulating Peritoneal Sclerosis
				Pathogenesis
				Diagnosis
				Treatment
				Prognosis
		Metabolic Complications
			Dyslipidemia and Insulin Resistance
			Hypokalemia
			Hypermagnesemia
		Other Complications
			Hemoperitoneum
				Pathogenesis
				Diagnosis
				Management
			Acute Pancreatitis
				Pathogenesis
				Diagnosis
				Management
				Prognosis
		References
	18: Remote Patient Monitoring in Peritoneal Dialysis
		Introduction
		Remote Monitoring Techniques
		Benefits of RPM
		RPM Implementation and Data Handling
		Regulatory Issues and Reimbursement
		Conclusion
		References
Part IV: Hemodialysis
	19: Hemodialysis Vascular Access in Children
		Background
		Vein Preservation in Children with CKD
		Hemodialysis Vascular Access Choices and Outcomes
		Arteriovenous Fistula
			General Remarks, Patient Evaluation, and Preparation
			Placement and Perioperative Handling
			Monitoring and Complications
		Arteriovenous Graft
			General Remarks, Evaluation, and Preparation
			Placement and Perioperative Handling
			Monitoring and Complications
		Central Venous Catheters
			General Remarks, Evaluation, and Preparation
			Placement and Perioperative Handling
			Monitoring and Complications
		Summary
		References
	20: Technical Aspects of Hemodialysis in Children
		Introduction
		The Extracorporeal Blood Circuit (Fig. 20.1)
		Hemodialyzer
		Hemodialyzer Membranes
		Sterilization and Reuse
		Blood Tubing
		Blood Pump
		Heparin Pump
		The Dialysate Circuit (Fig. 20.2)
			Water Purification
			Dialysate
		Dialysate Flow Rates
		Ultrafiltration Control
		Safety and Monitoring Systems
			Pressure Monitors
			Air Trap
			Blood Leak Monitors
			Conductivity Monitor
		Non-invasive Blood Volume Monitoring
		Dialysance and Online Monitoring of Clearance
		Maintenance
			Disinfection and Sterilization
			Descaling
		Complications and Troubleshooting
			Dialyzer Reactions and Biocompatibility
		Hemodialysis Technique Variations
			Hemodiafiltration
			Single-Needle Dialysis
		Summary
		References
	21: Haemodiafiltration: Principles, Technique, and Advantages over Conventional Haemodialysis
		Introduction and Defining a Need for Convective Clearance on Dialysis
		Principles of Solute Clearance by HD and HDF
			Haemodialysis (HD)
			Haemodiafiltration (HDF)
			Haemofiltration (HF)
		Definition and Types of HDF Therapy
		Modes of HDF
			Post-dilution HDF
			Pre-dilution HDF
			Mid-dilution HDF
			Mixed Dilution HDF
		Choosing the Optimal HDF Modality
		Requirements for HDF and Technical Aspects
			‘Ultrapure’ Water for HDF
			High-Flux Membranes
			Dialysis Machines with Accurate Ultrafiltration Control
			Calculation of Solute Clearances in HDF
			The Concept of ‘Backfiltration’
		Writing a HDF Prescription
		Practical Guide for the Optimization of the Convective Volume
		Clinical Studies and Potential Advantages of HDF over Conventional HD
			HDF: Potential Advantages over Conventional HD
			Studies in Adults
			Studies in Children
		Conclusions
		References
	22: Maintenance Hemodialysis During Infancy
		Introduction
		Epidemiology/Indications
		Technical Issues
			Vascular Access
			Equipment (Machines/Dialyzers/Blood Lines)
			Blood Flow
			Connection and Disconnection
			Anticoagulation
			Ultrafiltration (UF) and Dry Weight Assessment
			HD Schedule
		Clinical Problems
			Growth
			Anemia
			Hypertension
			CKD/MBD
			Psychosocial Impact
		Outcomes
		Conclusions
		References
	23: Home Haemodialysis in Children
		Introduction
		Rationale for Augmented Home HD
		Home HD Prescriptions
		Setting Up a Paediatric Home HD Program
			Patient Selection Criteria
			Infrastructure
			Finances and Business Case
			Safety
				Vascular Access
				Anticoagulation
				Family Centric Remote Monitoring and Support
				Effective Training and Education Program
			Staffing
			Dialysis Equipment
				Dialysis Systems Requiring Home Water Conversions
				Mobile HD System: NxStage™
		Adult Home HD Experience
		Paediatric Home HD Experience
		Summary
		References
	24: Infectious Complications of Hemodialysis in Children
		Hemodialysis Access in Children
		HD Catheters and Infection: Greater Risks with Children
		Catheter-Related Bloodstream Infections
			Incidence and Epidemiology of CRBSI
			Pathogenesis and Risk Factors for CRBSI
			Microbial Colonization and Biofilm
			Clinical Risk Factors for CRBSI
			Clinical Presentation of CRBSI
			Diagnosis of CRBSI
			Initial Clinical Management of Suspected CRBSI
			Catheter Replacement
			Catheter In Situ Treatment: Antimicrobials for Empiric and Calculated Therapy
			Antibiotic Therapy: Specifics of Provision
			Antimicrobial Locks in CRBSI
		Role of Strategies to Prevent CRBSI
			Staphylococcus Colonization
			Exit Site Care
			HD Catheter Hubs
			Innovative HD Catheter Design and Composition
			Antimicrobial Locks as Preventative Strategy
		Exit Site and Tunnel Infections
		AVF and AVG Infections
		Transmissible Infections in the Pediatric Hemodialysis Unit
		Infection Prevention and Surveillance
		Conclusion
		References
	25: Non-infectious Complications of Hemodialysis in Children
		Introduction
		Acute Complications
			Dialysis Disequilibrium Syndrome (DDS)
			Acute Hemodynamic Changes
				Intradialytic Hypotension
				Intradialytic Hypertension
			Blood and Circuit Component Reactions
				Allergic Reactions
				Air Embolism and Microbubbles
				Miscellaneous Complications
		Chronic Hemodialysis Complications
			Sleep Disorders
			Dialysis-Related Amyloidosis
		Conclusion
		References
Part V: Management of Secondary Complications of Chronic Dialysis
	26: Nutritional Assessment and Prescription for Children Receiving Maintenance Dialysis
		Introduction and Overview
		Nutrition Overview for Hemodialysis
		Nutrition Overview for Peritoneal Dialysis
		Growth
		Nutrition Assessment
			Anthropometric Evaluation
			Plotting Growth
			Other Measures
			Dietary Evaluation
			Nutrition-Focused Physical Exam
		Prescribing Nutrition
			Energy and Macronutrient Needs
				Protein
				Carbohydrate and Fat
		Micronutrient Needs
			Electrolyte Management
			Bone Mineral Management
			Vitamins
			Minerals
		Fluid Management
		Age-Based Considerations
			Infants and Young Children
				Enteral and Oral Formula or Breast Milk Feeding
				Transition to Oral Feeding
			Childhood
			Adolescents and Young Adults
				Nutrition Considerations for Preparation of Transfer to Adult-Focused Facilities
		Special Considerations
			Prematurity
		Protein Energy Wasting/Uremic Failure to Thrive
		Overweight and Obesity
		Parenteral Nutrition/IDPN
		Nutrition Counseling Strategies
		Nutrition Considerations in Preparation for Transplant
		Summary
		References
	27: Controlled Enteral and Parenteral Nutrition in Children on Dialysis
		Introduction
		Rationale for Nutritional Supplementation in Pediatric CKD
		Indications for Supplemental Nutritional Support
		Indications for Tube Feeding
		Evidence for Benefits of Tube Feeding: Infants
		Evidence for Benefits of Tube Feeding: Older Children
		Nasogastric (NG) Versus Gastrostomy Tube Feeding
		Practical Aspects of Enteral Tube Feeding
		Gastrointestinal Disturbances in Children with CKD
		Impaired Oromotor Development
		Transition to Oral Feeding
		Intradialytic Parenteral Nutrition (IDPN) and Intraperitoneal Nutritional Supplementation
		Summary
		References
	28: Growth and Pubertal Development in Children and Adolescents Receiving Chronic Dialysis
		Introduction
		Final Height and Height Prediction
		Clinical Presentation
			Intrauterine Growth
			Growth During Infancy
			Growth During Mid-childhood
			The Pubertal Phase
				Pubertal Development
				Pubertal Growth
				Segmental Growth
		Etiology of Growth Failure in Chronic Kidney Disease
			Underlying Renal Disease
			Consequences of Renal Disease
				Protein-Calorie Malnutrition
				Metabolic Acidosis
			CKD-Mineral and Bone Disorder (CKD-MBD)
			Anemia
			Physical Activity
		Endocrine Changes
			Gonadotropic Hormone Axis
				Gonadal Hormones
					Gonadotropins
			Somatotropic Hormone Axis
				Growth Hormone Secretion and Metabolism
				Growth Hormone Receptor and GH Signaling
				Insulin-Like Growth Factor Plasma Binding and Tissue Action
		Treatment of Growth Failure in Chronic Kidney Disease and on Dialysis
			General Measures
			Correction of Acid-Base/Electrolyte Abnormalities
			Dialysis and Intensified Dialysis
			Transplantation
			Endocrine Therapies
				Active Vitamin D
					Calcimimetics
				Growth Hormone
			Efficacy of rhGH in Prepubertal Children
			Effects of rhGH on Pubertal Growth and Final Height
			Efficacy of rhGH in Infants
			General rhGH Treatment Strategies
			Potential Adverse Events Associated with rhGH Therapy
		Future Perspectives
		References
	29: The Management of CKD-MBD in Pediatric Dialysis Patients
		Introduction
		Changes in Mineral Metabolism with Progressive CKD
		Effects of Non-mineral Factors on CKD-MBD
		Assessment of CKD-MBD in Children Undergoing Maintenance Dialysis
		Which Targets for PTH in Pediatric Dialysis?
		Management of CKD-MBD in Children Undergoing Maintenance Dialysis
		Effects of Primary Kidney Diseases Inducing a Specific Bone Impairment in Addition to CKD-MBD
		Conclusion and Perspectives
		References
	30: The Cardiovascular Status of Pediatric Dialysis Patients
		Epidemiology of CVD in CKD Patients
		Cardiovascular Disease Begins Early in the Course of CKD
		Risk Factors for the Development of CVD in CKD
			“Traditional” Risk Factors
			Uremia-Related Risk Factors
		Surrogate Measures of Cardiovascular Risk in CKD Patients
		Left Ventricular Structure and Function
		Vascular Structure, Function, and Coronary Artery Calcification (CAC)
		Progression of Vascular Calcification Through Different Stages of CKD
		Physiological Inhibitors of Calcification
		The Role of Vitamin D in Cardiovascular Health in CKD
		The Vascular Biology of Calcification
		The Bone-Vascular Link
		Evaluation and Management of CV Risks in CKD
		The Need for More Frequent Dialysis
		Management of Key Modifiable Risk Factors That Contribute to the Development and Progression of CVD in CKD
			Prevention and Treatment of Hypertension and LVH
			Ca–P–PTH and Vitamin D Management
			Prevention and Treatment of Lipid Abnormalities
			Supportive Treatment
		Conclusion
		References
	31: Management of Hypertension in Pediatric Dialysis Patients
		Introduction
		Prevalence of Hypertension in Pediatric Dialysis Patients
		Etiology of Hypertension in Pediatric Dialysis Patients
		Short- and Long-Term Consequences of Hypertension
			Hospitalization
			Alterations of Vascular Morphology and Function
			Left Ventricular Hypertrophy
			Cardiovascular Mortality
		Diagnosis of HTN in Dialysis Patients
			Role of Ambulatory Blood Pressure Monitoring (ABPM)
				ABPM in Hemodialysis Patients
				ABPM in Peritoneal Dialysis Patients
		Treatment of Hypertension
			Adjustment of Dry Weight/Optimization of Dialysis
				Dry Weight
				Optimization of Dialysis
			Dietary Intervention: Fluid and Salt Intake
			Pharmacological Treatment
			Native Nephrectomy
		Summary
		References
	32: Management of Anemia in Children Receiving Chronic Dialysis
		Introduction
		Normal Erythropoiesis and Disordered Mechanisms in Kidney Disease
			Hypoxia Stimulates New Red Blood Cell Production
			Iron Is Required for the Synthesis of Hemoglobin
			Hepcidin Regulates the Ferroportin-Based Movement of Iron
		Epidemiology of Anemia in Children on Dialysis
			Definition of Anemia
			Incidence, Prevalence, and Risk Factors
			Adverse Associations
		Clinical Management of Anemia
			Symptoms of Anemia
			Initial Diagnostic Evaluation of Anemia
			Erythropoietin Levels
			Laboratory Assessment of Iron Status
			Goal Hemoglobin Levels in Children on Dialysis
		Recombinant Human Erythropoietin Therapy
			Available Forms of rHuEPO
			Epoetin
			Darbepoetin Alfa
			CERA
			ESA Dosing for Children
			Children May Require Higher Absolute ESA Doses than Adults
			Safety of ESA Therapy
		Novel Erythropoiesis-Stimulating Agents
		ESA Hyporesponsiveness: Definition and Risk Factors
			Bone Disease Secondary to Hyperparathyroidism
			Medications
			Aluminum Toxicity
			Hypervolemia
			Anti-rHuEPO Antibodies
		Red Blood Cell Transfusion
		Iron Therapy
			Oral Iron Supplementation
			Intravenous Iron Supplementation
			Iron Safety
			Novel Routes of Iron Supplementation
		Future Directions
		References
	33: Immune Function and Immunizations in Dialyzed Children
		Introduction
		Immune Dysfunction
			White Blood Cell Differentiation and Function
			Phagocytic Cells and Receptors
			Immunoglobulins
		Immunizations
			Diphtheria, Tetanus, and Pertussis Vaccine
			Haemophilus influenzae Type b (Hib) Conjugate Vaccine
			Hepatitis B Vaccine
			Inactivated Polio Virus Vaccine
			Measles, Mumps, Rubella Vaccine
			Varicella Zoster Vaccine
			Pneumococcal Vaccine
			Hepatitis A, Meningococcal, Human Papillomavirus, and Rotavirus Vaccines
			Influenza Vaccine
			Bacille Calmette-Guerin (BCG) Vaccine
		Summary
		References
	34: Neurocognitive Functioning in Pediatric Dialysis
		Introduction
		The Interaction of Brain Development, Kidney Disease, and Dialysis
			Brain Development
			Kidney-Brain Connections
			The Impact of Dialysis on Kidney-Brain Connections
		Neurocognitive Functioning and Neuroimaging in Pediatric Dialysis
			Neurocognitive Functioning in Pediatric Dialysis
			Neuroimaging Findings in Pediatric Dialysis
		Management of Cognitive Dysfunction in Children on Dialysis
			Early Intervention
			School Age
			Adolescence and Adult Transition
		Conclusions and Directions
		References
	35: Psychosocial Adjustment and Adherence to Prescribed Medical Care of Children and Adolescents on Dialysis
		Psychosocial Adjustment
			Child Adjustment
			Parent and Family Adjustment
			Treatment of Psychosocial Problems
		Adherence to Prescribed Medical Regimens
			Assessment of Adherence
			Factors Associated with Adherence
			The Impact of Treatment Adherence on Health and Other Outcomes
			Interventions to Promote Adherence
		Summary and Directions for Future Research
		Implications for Clinical Practice and Psychosocial Care
		References
Part VI: Drugs and Dialysis
	36: Drug Administration and Pharmacogenomics in Children Receiving Acute or Chronic Renal Replacement Therapy
		Introduction
		Basic Concepts of Drug Disposition
		Absorption
		Distribution
		Biotransformation/Elimination
		Alteration of Drug Disposition in Renal Failure and Dialysis
		Hemodialysis
		Continuous Renal Replacement Therapies
		Peritoneal Dialysis
		Dosing Strategies in Children with Renal Failure
		Future Considerations: Pediatric Pharmacogenetics
		References
	37: Role of Radiological Assessment and Intervention in Pediatric Dialysis
		Introduction
		Classification of Contrast Media
		Iodinated Contrast Media
		Renal Handling of Contrast Media
		Mechanisms for Toxicity of Iodinated Contrast Media
		Dialysis in the Removal of Iodinated Contrast Media
		Dialysis as a Strategy to Minimize Contrast-Induced Nephropathy
		Negative Contrast Media
		Ferumoxytol
		Gadolinium
		Renal Handling of Gadolinium
		Mechanisms for Toxicity of Gadolinium
		Dialysis in the Removal of Gadolinium
		Nephrogenic Systemic Fibrosis
		Creation and Maintenance of Venous Access for Hemodialysis
		Role of Imaging for Acquired Cystic Kidney Disease
		References
	38: Extracorporeal Therapy for Drug Overdose and Poisoning
		Introduction
		Poison Characteristics
		Management of the Poisoned Patient
		Pharmacokinetic Concepts
			Molecular Weight
			Volume of Distribution
			Protein Binding
			Hydro- and Lipophilicity
			Ionization
			Intercompartmental Transfer
			Rebound
			Endogenous Clearance
			Toxicokinetics
			Specific Issues in Neonates and Young Infants
		Extracorporeal Clearance
		Extracorporeal Modalities
			Intermittent Hemodialysis (IHD)
			Continuous Renal Replacement Therapy (CRRT)
			Sustained Low-Efficiency Dialysis (SLED)
			Therapeutic Plasma Exchange (TPE)
			Exchange Transfusion
			Hemoperfusion
			Molecular Adsorbent Recirculating System (MARS)
			Single-Pass Albumin Dialysis (SPAD)
			Peritoneal Dialysis
		Therapeutic Decisions
			Acetaminophen
			Salicylates
			Barbiturates
			Carbamazepine
			Valproic Acid (VPA)
			Phenytoin
			Lithium
			Methanol
			Ethylene Glycol
			Metformin
		Conclusion
		References
Part VII: Outcome of Chronic Dialysis
	39: Long-Term Outcome of Chronic Dialysis in Children
		Introduction
		Epidemiology
			Worldwide and Nationwide Registries
			Age, Modality, and Primary Kidney Disease at the Start of Dialysis
		Long-Term Dialysis in Pediatric Patients
			Patient Survival
			Mortality Rate
			Cause of Death
			Mortality Risk
			Technique Failure Rate
		Complications of Long-Term Dialysis
			Cardiovascular Disease
				Long-Term Dialysis and CVD in Adults
				Long-Term Dialysis and CVD in Children
			Chronic Kidney Disease-Mineral and Bone Disorder
				Bone Disease
				Vascular and Valvular Calcification
				Longitudinal Growth
			Peritoneal Dysfunction and Encapsulating Peritoneal Sclerosis (EPS)
				Peritoneal Dysfunction
				Encapsulating Peritoneal Sclerosis
					Pathophysiology
					Incidence of EPS
					EPS Development Can Be Predicted
					Risk Factors
					PD Duration
					Composition of Dialysate
					Peritonitis
					Discontinuation of PD
					Drugs
				Diagnosis of EPS
					Clinical Diagnosis
					Radiological Diagnosis
					Pathological Diagnosis
				Treatment
					Surgery
					Nutritional Support
				Outcome
				Prevention
				Cognitive Functioning
			Quality of Life
			Social Outcome
		Conclusion
		References
	40: Health-Related Quality of Life of Children and Adolescents on Dialysis
		Introduction
		Assessment of HRQOL
			Child Health and Illness Profile (CHIP)
			Child Health Questionnaire
			PedsQL Generic Core Scales
			PedsQL ESRD Module
		Early Investigations of the Quality of Life of Youth on Dialysis
		Current Findings: Quality of Life of Youth on Dialysis
		Comorbidities and HRQOL
		Conclusions
		References
	41: Transition and Transfer to Adult Care for Adolescents and Young Adults with Advanced Chronic Kidney Disease
		Introduction
		Clinical Vignettes
		Overview
		Named Healthcare Worker and Transition Champion
		Starting Early
		Attention to Psychosocial Issues and Needs, Including Educational Challenges
			Adherence to Treatment, Despite Asynchronous Brain Development
			Acceptance That the Disease Does Not End with Childhood
			School and Vocational Training in Difficult Circumstances
			Additional Challenges in Special Social Situations
		Regular Evaluation of Adherence
		Patient and Family Engagement and Empowerment
		Regular Assessment of Transition Preparation Using Standardized Tools
		Tracking Progress of Individual Patients and of the Clinic’s Transition Process as a Whole
		Timing of Transfer
		Succinct Relevant Patient Transfer Summaries
		A Personalized Health Passport or Summary Document for the Patient
		Open Bidirectional Communication Between the Pediatric and Adult Teams
		Recognition by the Adult Team of the Young Adult’s Developmental Needs
		Continuation of the Transition Process After Transfer to Adult Care, Until the Young Person Is Fully Integrated and Able to Function in the Adult System
		Education and Training for Healthcare Professionals
		Financial Considerations
		Quality Improvement and Research
		Public Policy
		Summary
		References
	42: Ethical Decision-Making in Pediatric Dialysis
		Introduction
		Ethical Considerations in Withholding and Withdrawing Dialysis Treatment
			The History of Dialysis Provision and Ethical Implications
			Best Interest Standard and Harm Principle in Pediatric Decision-Making
			The Technological Imperative
			Equivalence of Withholding and Withdrawing Dialysis
			Considerations for Forgoing Dialysis
			Process of Forgoing Dialysis
			Disagreement
			Futility
			Allocation of Resources
			Time-Limited Trials
		Special Populations
			Suspected ESKD in the Antenatal Period
			Suspected ESKD in the Neonatal Period
			Developmentally Disabled Children and Those with Significant Comorbidities
			Children Who Are Not Transplant Candidates
			Undocumented Immigrants/Refugees
			Adolescents Who Make a Request to Forgo Dialysis
		Conclusions
		References
Part VIII: Special Indications, Techniques and Applications
	43: Diagnosis and Treatment of Acute Kidney Injury in Children and Adolescents
		Introduction
		Diagnosis of Acute Kidney Injury
			Definition of AKI
			Epidemiology and Outcomes of AKI
				Incidence and Short-Term Outcomes
				Risk Factors
				Long-Term Outcomes
			Pathophysiology of AKI
			Clinical Evaluation of AKI
				Classification and Etiology (Table 43.3)
				History and Physical Examination (Table 43.4)
				Diagnostic Laboratory Evaluation (Table 43.5)
		Management of Acute Kidney Injury
			AKI Management Prior to Renal Support Therapy
				Investigational Strategies to Risk-Stratify AKI
				Fluid Management
				Electrolyte Management
				Pharmacological Therapy
			Timing and Modality of Renal Support Therapy
				Modality of RST
			Performing Acute Peritoneal Dialysis for AKI
				Access
				Acute Peritoneal Dialysis Prescription (Table 43.6)
				Complications
			Acute Hemodialysis for AKI
				Acute Hemodialysis Prescription
			Continuous Renal Replacement Therapy for AKI
				Vascular Access (Table 43.8)
				CRRT Machine and Modality (Fig. 43.3)
				Hemofilter and Blood Prime
				Solutions (Table 43.9)
				CRRT Prescription: Blood Flow (Table 43.10)
				CRRT Prescription: Solute Clearance (Table 43.10)
				CRRT Prescription: Ultrafiltration (Table 43.10)
				Anticoagulation
				CRRT Complications
			Nutritional Management for AKI and RST-AKI
			Drugs in AKI
		Conclusion
		References
	44: Neonatal Acute Kidney Injury
		Introduction
		Case Presentation
		Defining Neonatal AKI
		Consequences and Medical Management of AKI
			Fluid Overload
			Fluid Management
			Dysnatremias
			Hyperkalemia
			Metabolic Acidosis
			Hyperphosphatemia and Hypocalcemia
			Nutrition and Other Metabolic Alterations
			Limiting Nephrotoxin Exposure
		Other Medical Treatments of Neonatal AKI
		Indications for Renal Replacement Therapy (RRT)
		Renal Replacement Therapy Modalities
		Peritoneal Dialysis
		Extracorporeal Therapies
			Vascular Access
			Fluid to Prime Machine
			Continuous Versus Intermittent Duration
				Hemodialysis
				CRRT
		Newer RRT Machines for Young Infants
		References
	45: Acute Kidney Injury in Less Well-Resourced Countries
		Introduction
		Epidemiology and Etiology
		Diagnostic Evaluation (See Also Chaps. 43 and 44)
			Clinical Evaluation
			Laboratory Evaluation
		Management
			Therapy of Complications
			Management of Fluid and Electrolytes
			Pharmacologic Therapy
			Nutrition
			Fluid Administration
			Fluid Boluses
			Fluid Overload
			Drugs to Remove Fluid
			Drug Administration
			Renal Replacement Therapy (RRT): Table 45.1
		Outcomes
		References
	46: Extracorporeal Liver Support Therapies for Children
		Introduction
		Indications for Extracorporeal Liver Support Therapy
			Acute and Acute-on-Chronic Liver Failure
			Cholestatic Pruritus
		Artificial Liver Support Devices
			Combined Plasma Exchange and Hemodialysis Therapies
			Bioartificial Liver Support Devices
			Implementation of ELS
		Data for Extracorporeal Liver Support
		Outcome of ELS in Patients with Liver Failure
		Conclusion
		References
	47: Dialytic Therapy of Inborn Errors of Metabolism in Case of Acute Decompensation
		Introduction
		Clinical Manifestations and Laboratory Investigations
		Etiologies
		Treatment
		Nutritional and Pharmacological Management
		Metabolite Removal by Dialysis
		Hyperammonemic Disorders
		Maple Syrup Urine Disease (MSUD)
		Other Organic Aciduria
		Dialysis Equipment
			Catheter
			Dialyzer
			Dialysis Machines and Tubing
			Dialysis Management
		Clinical Outcomes
		References
	48: Therapeutic Apheresis in Children
		Introduction
		Principles of Separation
		Pediatric-Specific Technical Considerations
			Vascular Access
			Extracorporeal Volume and Blood Priming
			Anticoagulation
			Volumetric Control
		Apheresis Treatment Modalities and Procedures
			Plasmapheresis
			Erythrocytapheresis
			Leukapheresis
			Plateletpheresis
			Photopheresis
			Lipoprotein Apheresis
			Immunoadsorption
		Indications for Apheresis Techniques
			ANCA-Associated Glomerulonephritis
			Thrombotic Microangiopathies
			Focal Segmental Glomerulosclerosis (Recurrent)
			Solid Organ Transplantation
		Summary
		References
	49: Evaluating and Preparing the Pediatric Dialysis Patient for Kidney Transplantation
		Introduction
			Historical Context
			Benefits of Transplant Over Dialysis
		Transplant Referral: Timing and Indications
		Surgical Considerations
		Medical and Immunological Considerations
		Psychosocial Considerations
		Evaluation to Transplant
		Deceased Donation
		Living Donation
		References
	50: The Spectrum of Patient and Caregiver Experiences
		Introduction
		The Patient Experience
			Feeling Different
			Loss of Control
			Lifestyle Restrictions
			Managing Treatment
			Coping Strategies
		The Caregiver Experience
			Emotional Turmoil and Uncertainty
			Loss of Control
			Change in Family Dynamics
			Lifestyle Restrictions
			Caregiver Burden
			Financial Burden
			Personal Growth
		Implications for Practice
		Conclusion
		References
Index