Clinical morbidity in pediatric dialysis patients: data from the Network 1 Clinical Indicators Project

The Health Care Financing Administration (HCFA) has gathered clinical data on end stage renal disease (ESRD) patients since 1994, but details are only available on patients greater than or equal to 18 years. In this report, we present morbidity data collected prospectively over 12 months from all children (1-18 years) maintained on either hemodialysis (HD) or peritoneal dialysis (PD) within the six-state New England area. During this year, 17 observations were recorded on 14 HD patients (age 13.4 +/- 11.3 years) and 36 observations were made on 25 PD patients (age 11.5 +/-4.8 years; mean SD). These patients were generally highly functional, attending school at least part time in nearly all cases. Dialysis adequacy index (DAI), defined as the delivered KT/V divided by DOQI guideline values, indicated that patients were well dialyzed (HD 1.41 +/-0.1 and PD 1.10 +/-0.1; mean +/- SE). When all dialysis patients were grouped and analyzed, the DAI did not correlate with number of hospitalizations, degree of anemia, serum albumin, or type of dialysis. The number of hospitalizations were greater the younger the patient (P <0.01). The need for antihypertensive medications was higher in the children maintained on HD (94%) compared to children on PD (58%) (P <0.01). Lastly, while serum ferritin did not correlate with serum iron, hematocrit or Epo dosage, it was inversely related to serum albumin (P <0.03). We conclude that, in children, (1) exceeding suggested dialysis adequacy may not improve patient morbidity, (2) the need for antihypertensive medications appears greater in children maintained on HD, and (3) inflammation may play a role in determining serum albumin independent of nutrition.