Optimal care of the pediatric end-stage renal disease patient on dialysis

This manuscript is an effort on behalf of the American Society of Pediatric Nephrology to provide recommendations designed to optimize the clinical ca re of pediatric patients with end-stage renal disease (ESRD). Although many of the recommendations are evidenced-based with the supporting data being derived from a variety of sources, including patient registries, others are opinion-based and derived from the combined clinical experience of the aut hors. In all cases, it is recommended that the decision to initiate dialysi s should be made only after an assessment of a combination of biochemical a nd clinical characteristics. Irrespective of the choice of dialysis modalit y (hemodialysis v peritoneal dialysis), dialysis efficacy should be measure d regularly, and the dialysis prescription should be designed to achieve ta rget clearances. Attention to dialysis adequacy, control of osteodystrophy, nutrition, and correction of anemia is mandatory, because all may influenc e patient outcome in terms of growth, cognitive development, and school per formance. Finally, the availability of a multidisciplinary team of pediatri c specialists is desirable to provide all facets of pediatric ESRD care, in cluding renal transplantation, in an optimal manner. Future clinical resear ch efforts intended to address topics such as dialysis adequacy, anemia man agement, and growth should be encouraged. (C) 1999 by the National Kidney F oundation, Inc.