| 书目名称 | Pediatric Dialysis Case Studies | | 副标题 | A Practical Guide to | | 编辑 | Bradley A Warady,Franz Schaefer,Steven R. Alexande | | 视频video | | | 概述 | A collection of common and challenging clinical cases of pediatric patients who recieve acute and chronic dialysis therapy.Each case is succinctly described and followed by a discussion of patient eva | | 图书封面 |  | | 描述 | .Edited by the same team that developed the successful .Pediatric Dialysis. and its second edition, this text features clinical management principles that are integral to the care of children receiving chronic dialysis. Each chapter is introduced by a case presentation that serves as the basis for key learning points that are clinically applicable and presented in a succinct manner. The topics included in .Pediatric Dialysis Case Studies. cover virtually all aspects of pediatric dialysis care and represent the efforts of an international group of experts with firsthand clinical expertise from all disciplines represented in the pediatric dialysis team. This resource is certain to help the clinician achieve improved outcomes for these often complex patients.. | | 出版日期 | Book 2017 | | 关键词 | Hemodialysis; Intoxications; Nutritional Management; Pediatric dialysis; Peritoneal access; Vascular acce | | 版次 | 1 | | doi | https://doi.org/10.1007/978-3-319-55147-0 | | isbn_softcover | 978-3-319-85579-0 | | isbn_ebook | 978-3-319-55147-0 | | copyright | Springer International Publishing AG 2017 |
| 1 |
,Peritoneal Access, |
Richard J. Hendrickson MD, FACS, FAAP,Walter S. Andrews MD, FACS, FAAP |
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Abstract
Children who develop acute or chronic kidney failure may require dialysis either temporarily or chronically, depending upon their clinical status and renal function. There are two modes of dialysis, either hemodialysis or peritoneal dialysis. The preferred approach in children, especially neonates and infants, is peritoneal dialysis. The following case presentation will discuss peritoneal access for peritoneal dialysis.
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| 2 |
,Peritoneal Equilibration Testing and Application, |
Francisco J. Cano |
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Abstract
The peritoneal equilibration test (PET) represents a semiquantitative method to assess the peritoneal membrane permeability in dialyzed patients and a very important tool in the individualized prescription of peritoneal dialysis (PD) therapy. The PET permits patients to be categorized as low, low-average, high-average, or high transporters which, in turn, helps determine the best PD prescription characteristics in terms of fill volume, length of each exchange, and dextrose concentration of the dialysis solution..Slow transporters should be treated with long-dwell exchanges and large fill volumes to optimize solute clearance, while fast transporters will benefit from the use of short-time dwells during the night, and keeping 1 or 2 long-time exchanges during the day when necessary. Growth in children and long-term outcome in adults on PD have been associated with peritoneal transport categories. A routine evaluation of peritoneal transport is indicated when there is clinical evidence of changes in dialysis efficiency, especially when the changes have the potential of influencing cardiovascular morbidity and mortality in uremic children.
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| 3 |
,Peritoneal Dialysis Prescription, |
Nathan T. Beins,Bradley A. Warady |
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Abstract
This chapter presents the case of a 3-year-old male with history of posterior urethral valves and associated end-stage renal disease dependent upon peritoneal dialysis. The chapter proceeds to discuss the primary components of the peritoneal dialysis prescription and how to utilize Kt/.. calculations to determine the adequacy of a dialysis prescription. The process of developing a peritoneal dialysis prescription including selecting a fill volume, dwell time, peritoneal dialysis modality, and peritoneal dialysis solution is discussed. Peritoneal equilibration testing is introduced and details regarding its interpretation are provided.
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| 4 |
,Dialysis During Infancy, |
Joshua J. Zaritsky MD, PhD,Bradley A. Warady MD |
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Abstract
Although end-stage renal disease (ESRD) is rare in infants, its development can be associated with significant morbidity and mortality. Only through the provision of experienced, multidisciplinary care can a favorable outcome be anticipated. Peritoneal dialysis is the renal replacement modality of choice for this age group and serves as an essential bridge until successful renal transplantation can occur. Using a case-based approach, we discuss the practice of peritoneal dialysis in infants including the unique ethical and technical considerations facing pediatric nephrologists and caregivers. Additionally, we review current guidelines concerning nutrition as well as the literature on complications and outcomes.
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| 5 |
,Hypotension in Infants on Peritoneal Dialysis, |
Enrico Vidal |
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Abstract
Infants and small children receiving chronic peritoneal dialysis (PD) are particularly prone to chronic hypotension, because of the risk for hyponatremic hypovolemia that is related to their primary renal disease, specific nutritional needs, and peritoneal membrane characteristics. In this setting, if an acute “second” hit leads to a further decline in blood pressure, perfusion pressure autoregulatory mechanism may fail, leading to severe cerebral ischemic complications. Anterior ischemic optic neuropathy represents an acute ischemic disorder of the optic nerve head and a dramatic cause of sudden blindness. It occurs in about 1% of children on chronic PD. In infants at risk, specific strategies tackling the pathophysiological cascade should be applied to prevent PD-induced hypotension and its complications.
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| 6 |
,Ethical Dialysis Decisions in Infants with End-Stage Kidney Disease, |
Aviva M. Goldberg MD, MA, FRCPC |
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Abstract
End-stage kidney disease (ESKD) in newborns requires careful ethical decision making, since the burdens and benefits of dialysis in this age group can differ from those of older children, and because it may be difficult to accurately prognosticate renal outcomes in the prenatal period. This chapter will review the available prognosis data for children born with ESKD, the ethical issues that can arise in the decisions about whether dialysis should be offered to newborns and if it can be refused, and the moral distress that can arise for healthcare professionals and families faced with this difficult decision. The importance of prenatal counseling and involvement of allied health professionals in reaching a decision and supporting the family is also reviewed.
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| 7 |
,Catheter Exit-Site and Tunnel Infections, |
Christine B. Sethna MD, EdM |
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Abstract
Catheter-related infections, namely, exit-site infections (ESIs) and tunnel infections (TIs), are significant complications of peritoneal dialysis (PD) in children. ESIs and TIs should be identified early and treated promptly as they are associated with an increased risk for peritonitis. The diagnosis of ESIs and TIs is aided by a scoring system based on redness, tenderness, edema, and secretions at the exit/tunnel site. Optimal chronic catheter care measures such as cleansing with an antiseptic solution, proper hand washing, and topical antibiotic prophylaxis may prevent ESIs and TIs. Oral antibiotic treatment of ESIs with first generation cephalosporins or ciprofloxacin (for suspected .) is recommended empirically pending culture results. TIs can be treated with oral, intravenous, or intraperitoneal antibiotics. Treatment duration is generally 2–4 weeks and for at least 7 days after resolution of external symptoms. ESIs and TIs due to . can be difficult to treat and often result in catheter removal.
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| 8 |
,Peritonitis, |
Enrico Eugenio Verrina |
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Abstract
The first clinical case is that of a child with renal hypo-dysplasia and several nonrenal comorbidities and on peritoneal dialysis since the neonatal period. He underwent two abdominal interventions due to intestinal necrosis plus repeated peritoneal catheter replacements. At the age of 2 years, he experienced a methicillin-resistant . (MRSA) peritonitis originated from an exit-site/tunnel infection caused by the same organism. Peritonitis was effectively cured with intraperitoneal vancomycin, while persistent and antibiotic-resistant exit-site and tunnel infection was treated with local debridement and curettage, unroofing of the subcutaneous tunnel, and extrusion and shaving of the external Dacron cuff of the catheter. In this small child, local, conservative surgery was performed as an alternative to catheter removal taking into account his history of repeated catheter replacements and high operative risk..The second clinical case initially presented as an almost ordinary case of peritonitis in an apparently not-at-risk 4-year-old child who had been on peritoneal dialysis for 26 months. On day 3 of treatment, culture results showed that peritonitis was caused by a strain of ., whose occurrence and growth could have been facilitated by repeated, short courses of antibiotic treatment of recurrent urinary tract infections in a child with complex urinary tract abnormalities. After 2 days of treatment with fluconazole and no clinical improvement, the peritoneal catheter was removed, and fluconazole was replaced by caspofungin, by which the fungal infection was effectively treated. Serial determinations of 1-3-β-D-glucan in serum and peritoneal fluid, together with concomitant evaluation of clinical conditions and microbiology, were helpful to assess response to therapy and to optimize the timing of peritoneal catheter replacement.
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| 9 |
,Relapsing and Recurrent Peritonitis, |
Sevcan A. Bakkaloglu MD |
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Abstract
Peritonitis remains the most common and most significant complication of peritoneal dialysis (PD) in children. Although many PD patients experience none or only one peritonitis episode over their “lifetime” of PD treatment, it is in those patients who have repeated episodes of peritonitis that additional morbidity is most likely to occur. This chapter reviews information on peritonitis episodes that have occurred within 4 weeks of completion of the therapy of a previous peritonitis infection, so-called recurrent and relapsing peritonitis episodes. We will, in turn, present real-life cases to highlight the clinical issues that are commonly encountered by clinicians treating these infections.
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| 10 |
,Peritoneal Dialysis-Associated Hydrothorax and Hernia, |
Dagmara Borzych-Duzalka,Franz Schaefer |
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Abstract
An 8-month-old male infant with autosomal recessive polycystic kidney disease (ARPKD), necessitating bilateral nephrectomy in the fifth month of life, presented with acute tachypnea and hypotension 9 weeks after automated peritoneal dialysis (PD) commencement. Chest X-ray showed right-sided pleural effusion, and radiography with intraperitoneal installation of contrast agent established the diagnosis of paraesophageal leakage into the pleural space. Subsequent contrast thoracoscopy with intraperitoneal administration of methylene . failed to demonstrate the site of the leakage. Hence, PD with reduced fill volumes was resumed. Two weeks later the patient developed acute respiratory distress while on cycler. Open surgery demonstrated a 3 cm cleft in the right diaphragm. After its surgical closure, PD could be resumed successfully, but when fill volume was increased to 1000 ml/m., the patient developed a bilateral inguinal hernia, which required surgical repair.
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| 11 |
,Ultrafiltration Failure in Children Undergoing Chronic PD, |
Franz Schaefer |
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Abstract
Ultrafiltration failure (UFF) is a common cause of PD technique failure in children. The cases presented in this chapter illustrate two important causes of UFF: (1) membrane failure secondary to long-term PD and/or repeated peritoneal infections and (2) mechanical PD failure, in this case due to peritoneal disruption. The use of the peritoneal equilibration test to assess the type and extent of UFF is demonstrated. Approaches to prevent and treat UFF are discussed.
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| 12 |
,Encapsulating Peritoneal Sclerosis, |
Hiroshi Hataya,Masataka Honda |
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Abstract
Encapsulating peritoneal sclerosis (EPS) is an uncommon but extremely serious complication of long-term peritoneal dialysis (PD). It is diagnosed by a combination of clinical symptoms including bowel obstruction and radiological findings of features of encapsulating peritoneal fibrosis. The leading causes of death are mainly complications related to bowel obstruction. There are two major risk factors: peritoneal deterioration due to long-term PD and inflammation due to severe or recurrent peritonitis. Although many patients experience clinical symptoms following ultrafiltration (UF) failure, differentiating peritoneal sclerosis from EPS on the basis of UF failure alone is difficult from a pathological perspective..A computed tomography (CT) scan is recommended as the first-line modality in diagnosis due to its reproducibility. Treatment with medications such as corticosteroids, immunosuppressants, or tamoxifen has been reported, but there is yet little evidence in its support. In the advanced stages, surgical intervention is the treatment of last resort, to which experienced surgeons may have recourse. The mortality rate among adults with EPS is high. For pediatric EPS, the mortality rate is lower than that for adults, but the reasons remain unclear.
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| 13 |
,Difficult Vascular Access, |
Mary L. Brandt MD,Joseph L. Mills MD,Sarah J. Swartz MD |
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Abstract
Children with renal failure, with rare exception, inevitably experience failure of their hemodialysis access due to infection, clotting, stenosis, and/or thrombosis. Understanding the implications of these complications and how to plan for new access is key to providing sustainable dialysis in children.
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| 14 |
,Hemodialysis Prescription, |
Klaus Arbeiter,Dagmar Csaicsich,Thomas Sacherer-Mueller,Christoph Aufricht |
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Abstract
Performing hemodialysis in children requires integration of age-dependent factors into a prescription that acknowledges size, growth, and disease-specific aspects regarding the choice of equipment, settings, anticoagulation regimen, as well as dialysis dose and volume control. In particular, low extracorporeal blood volumes (and flow rates) in combination with growth-guided dietary needs represent specific challenges in the pediatric population that become particularly evident in multi-morbid patients with restricted dialysis settings. In this chapter, hemodialysis prescription is presented for two scenarios. In the first case, the rationale for clinical decision-making in a standard pediatric hemodialysis situation is discussed; in the second case, an uncooperative patient with severe mental retardation is presented to discuss the difficulties in providing acceptable hemodialysis with apparently inacceptable trade-offs in special situations.
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| 15 |
,Intensified Hemodialysis, |
Claus Peter Schmitt |
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Abstract
This chapter reports on the limitations of conventional thrice weekly hemodialysis and the various therapeutic options to improve dialytic clearance rates, fluid homeostasis, and blood pressure control by means of intensified hemodialysis and hemodiafiltration. Vascular access-related prerequisites, treatment targets, and the current scientific evidence on improved biochemical control, quality of life, and long-term outcome achieved with intensified hemodialysis in children and adults are reported and balanced against the potential psychosocial burden of more frequent and longer hemodialysis sessions. Complementary measures to improve and monitor treatment efficiency and outcome and to support the patient and caregivers are described.
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| 16 |
,Home Haemodialysis, |
Daljit K. Hothi,Kate Sinnott |
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Abstract
Once children develop renal failure, they require transplantation or dialysis to sustain life. The dialysis dose delivered by peritoneal dialysis (PD) and in-centre haemodialysis (HD) is just ‘adequate to save a life,’ but children’s well-being and health are dramatically compromised. The cardiovascular mortality rate of young adults on conventional dialysis therapies is equivalent to that of 85-year-olds without renal disease. Children struggle with fluid and dietary restrictions, and growth may be poor. In-centre HD demands travelling up to 3 hours to hospital three times per week for treatment. Children miss school and their home and social life is compromised..In contrast, home HD offers gentler dialysis, and the collected international experiences report superior outcomes. For the first time, dialysis outcomes are beginning to approach transplantation outcomes. Fluid and diet restrictions are lifted and most medications can be stopped. Children have improved energy and appetites and catch-up growth occurs. They return to full-time education and report better integration with friends and family activities. Home HD also offers financial benefits for individual units as the cost per treatment is lower than in-centre dialysis..It might be expected that home HD would result in a significant burden to the family. However, even though caregivers have expressed anxiety about managing the HD at home, they unanimously report being motivated by the positive difference that home HD has made to their children’s lives.
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| 17 |
,Myocardial Stunning, |
Daljit K. Hothi |
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Abstract
Cardiovascular mortality is grossly elevated in chronic hemodialysis (HD) patients with an 800-fold increase compared with age-matched controls. The relationship between hypertension and cardiovascular morbidity has long been recognized. However, there is mounting evidence implicating hypotension and not hypertension as the predominant risk factor for mortality in HD patients. It is also becoming increasingly apparent that HD in itself confers a risk, but the pathophysiological mechanisms remain elusive..The uremic milieu triggers a series of events that alters the cardiovascular compensatory responses to hemodynamic stresses. There is also evidence from isotopic, electrocardiographic, biochemical, and echocardiographic studies implicating HD as a source of recurrent subclinical myocardial cell injury, even in the absence of preexisting large-vessel epicardial coronary artery disease. Acute reductions in myocardial blood flow cause reversible, regional left ventricular (LV) dysfunction, consistent with the definition of myocardial stunning. The number of stunned segments and the intensity of stunning within segments correlate with intradialytic BP changes and UF volume. Within adult dialysis patients, transient myocardial ischemia precipitates cardiac arrhythmias and progresses to fixed regional systolic dysfunction and reduced global systolic function. Myocardial stunning during HD is amenable to treatment and can be ameliorated by biofeedback, cool temperature dialysis, and extended or more frequent HD.
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| 18 |
,Catheter-Related Bloodstream Infection, |
Rebecca L. Ruebner,Alicia M. Neu |
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Abstract
Hemodialysis access-related bloodstream infections are a significant cause of morbidity and mortality in children maintained on hemodialysis. The rates of these infections are highly variable in large part due to the inconsistent definitions used to diagnose these infections and the failure to clearly delineate between primary and access-related bloodstream infections. Although standard treatment of catheter-related bloodstream infections routinely includes removal of the catheter, this therapeutic maneuver is difficult to implement in hemodialysis patients who require that access for life-sustaining dialysis and in children in whom sites for vascular access may be limited. The following case seeks to highlight the importance of this distinction as well as the unique aspects of treating access-related infections in pediatric hemodialysis patients. The case discussion will also review efforts to minimize the risk for these infections.
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| 19 |
,Intradialytic Hypotension: Potential Causes and Mediating Factors, |
Lyndsay A. Harshman,Steven R. Alexander,Patrick D. Brophy |
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Abstract
Common causes of intradialytic hypotension include excessive ultrafiltration and/or use of antihypertensive medications prior to initiation of a hemodialysis treatment. An expanded differential diagnosis and evaluation may be required in cases of critically ill patients on hemodialysis – particularly those showing poor fluid responsiveness, elevation in lactate, or neurological changes. Care of the critically ill population mandates the need to be particularly aware of rare causes of intradialytic hypotension given preexistent malnutrition and accelerated clearance of water-soluble molecules as a result of renal replacement therapy.
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发表于 2025-3-21 16:40:45
