MAINTENANCE DIALYSIS IN NORTH-AMERICAN CHILDREN AND ADOLESCENTS - A PRELIMINARY-REPORT

During 1992 the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) began to develop a pediatric Dialysis Patient Data Bas e by collecting data on pediatric patients who had received either hem odialysis (HD) or peritoneal dialysis (PD), or both, at a participatin g NAPRTCS center. This preliminary report describes study methods and contains detailed, though short-term observations reported by 64 of 87 NAPRTCS centers on 762 patients who were <21 years of age at enrollme nt and who received treatment between January 1, 1992 and September 15 , 1992. In these 762 patients, a total of 810 independent courses of d ialysis therapy were identified (PD = 534 [65.9%]; HD = 276 [34. 1%]). Patient age groupings showed a significantly greater proportion of PD patients among younger age groups. Automated peritoneal dialysis was used by about 75% of registered PD patients at one and six months afte r registration. A total of 196 peritonitis episodes were reported, yie lding a peritonitis rate of one episode every 7.1 patient-months. Ten percent of PD catheters were replaced, primarily for mechanical malfun ction and leaks. Percutaneous catheters were used for vascular access in about one-half of the HD patients, with the remainder almost equall y divided between arteriovenous fistulae and grafts. Vascular access r evision was reported in 28% of HD patients, with about one-third of th ese revisions performed to create a more permanent access. Recombinant human erythropoietin therapy was used in 89% of PD and 94% of HD pati ents at six months. Recombinant human growth hormone therapy was used in 9% of PD and 5% of HD patients at six months. By six months, 36.9% of patients were on cadaver transplantation waiting lists, with transp lant recipient workups underway in an additional 21.9% of patients. Of the 40.5% of patients reported not to be actively pursuing transplant ation, 50% cited medical problems and 50% cited patient/family prefere nce as reasons. Nine patients died and 44 changed from one dialysis mo dality to the other. Infection complications predominated among PD pat ients who changed to HD, while psychosocial issues were more frequentl y cited reasons for HD patients to change to PD. The present report is preliminary and intended to be primarily descriptive. Future reports will examine in depth those issues introduced by the data presented in this report.