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Vascular access

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Pediatric Dialysis

Abstract

For children who require renal replacement therapy, peritoneal dialysis is the preferred choice for dialysis and early renal transplantation is the ultimate goal1. Hemodialysis has inherent disadvantages: It is technically difficult in small patients, it is not conducive to full time school attendance, and for children with arteriovenous fistulas (AVF) and grafts the psychological burden associated with painful needle sticks can be overwhelming2. Despite these limitations, when emergent dialysis is indicated, hemodialysis or continuous hemofiltration may be the only forms of therapy available for children with acute renal failure. Hemodialysis is also indicated for those children with more chronic renal disease who are not candidates for peritoneal dialysis, including those with chronic peritonitis, loss of membrane function, or those with caretakers who are unable or unwilling to perform the rigorous procedures of peritoneal dialysis at home. Because children with end-stage renal disease (ESRD) have a relatively longer life span compared to adults, it is likely they will require many courses of dialysis. Therefore, the critical issue for these patients is to provide adequate vascular access for the current need, while minimizing compromise to future access sites. Because this requires a different surgical philosophy, it is important to develop a team composed of surgeons and nephrologists interested in these unique challenges.

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Authors
  1. D. L. Cass
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  2. J. G. Nuchtern
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Editor information

Editors and Affiliations

  1. Children’s Mercy Hospital, University of Missouri, Kansas City School of Medicine, Kansas City, MO, USA

    Bradley A. Warady

  2. University Children’s Hospital, Heidelberg, Germany

    Franz S. Schaefer

  3. Health Science Center, State University of New York at Stony Brook, Stony Brook, NY, USA

    Richard N. Fine

  4. Lucille Packard Children’s Hospital at Stanford, Stanford University, School of Medicine, Stanford, CA, USA

    Steven R. Alexander

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Cass, D.L., Nuchtern, J.G. (2004). Vascular access. In: Warady, B.A., Schaefer, F.S., Fine, R.N., Alexander, S.R. (eds) Pediatric Dialysis. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-1031-3_5

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  • DOI: https://doi.org/10.1007/978-94-007-1031-3_5

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-3770-9

  • Online ISBN: 978-94-007-1031-3

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