Recent advances in chronic dialysis and renal transplantation in children

Excerpt

End-stage renal disease (ESRD) is a devastating chronic health problem in children, for which there is no life-long cure, not even after kidney transplantation. Fifty years ago, all children with ESRD died. The first pediatric dialysis programs were started in the 1960s, and the first pediatric renal transplantation took place in the 1970s [1]. During the 1980s there was a steady increase in numbers, and there has been relative stabilization since 2000. Now, almost all children with ESRD are treated with either long-term dialysis or renal transplantation. There has been an exponential increase in scientific literature in the field in the past two decades, particularly in the past 5 years (Fig. 1). Studies of outcomes over 20 years are now beginning to emerge [1, 2]. Children with ESRD still have high mortality rates, estimated to be 30-times higher than expected for age compared with those of healthy children. On the other hand, the long-term survival of renal transplants has dramatically improved. Such information is important for pediatric nephrologists in counseling patients and families. However, it is always tricky to extrapolate past performance data to the future. The favorable impact of advances in technology and pharmacology as well as the wider acceptance of living-donor transplantation has to be balanced against the negative impact of new sets of side-effects and the acceptance of more challenging patients, with severe and sometimes life-threatening co-morbidities, into the modern day dialysis and transplantation programs. In a series of teaching articles, we will summarize and integrate up-to-date clinical information and translate scientific discoveries into useful modules for application at the bedside. We aim to provide state-of-the-art summaries of the current knowledge and treatment guidelines for children with ESRD, which is also stage 5 chronic kidney disease (CKD). This is by no means an all-inclusive list, since many clinical and management issues are common to those in earlier stages of CKD and have been covered in an earlier series of teaching articles on CKD [3]. In each journal issue, there will be one article on long-term dialysis together with one renal transplantation article.

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