MANAGEMENT OF END-STAGE RENAL-DISEASE IN CHILDREN

OBJECTIVE: TO review the medical literature on management of end-stage renal disease (ESRD) and its complications in the pediatric patient. DATA SOURCES AND STUDY SELECTION: MEDLINE searches (1970-1997) of the English-language literature. Clinical trials and reviews of drug thera py management were included, and bibliographies were reviewed for rele vant articles. DATA SYNTHESIS: Principles of renal replacement therapy in children have been expanded to include maintenance of fluid and el ectrolyte balance and to manage the complications of ESRD in children. Types of renal replacement and their complications are reviewed. Comp lications of ESRD are reviewed with emphasis on drug therapy managemen t of anemia of chronic renal failure, growth retardation, and hyperten sion. A discussion of the use of vitamins and supplements to maintain bone and mineral homeostasis is provided, and specific recommendations for vaccination of children with ESRD are given. CONCLUSIONS: Childre n with end-stage renal failure present a unique challenge to the pharm acist. Renal replacement therapy for children with ESRD involves some form of dialysis and an intensive medication regimen. Complications mu st be treated with appropriate drug therapy. Drug therapy must be moni tored closely for dosage adjustment, clinical response, drug interacti ons, and toxicity. Patients and families must receive continuous educa tion and followup to encourage compliance. The pharmacist must work cl osely with the healthcare team to optimize drug therapy and improve pa tient education and compliance.