Outcome data on pediatric dialysis patients from the End-Stage Renal Disease Clinical Indicators Project

Network 1 (New England) initiated the Clinical Indicator Project to survey dialysis adequacy (Kt/V), nutrition (serum albumin level), and anemia manag ement in patients maintained on chronic dialysis, Because little informatio n is available in children, data were specifically recorded covering these variables in patients (age, 1 to 18 years) maintained on either hemodialysi s (HD) or peritoneal dialysis (PD). During the 18 months of data collection , 29 observations were recorded on 23 HD patients (age, 14.3 +/- 3.6 years) , and 43 observations were made on 30 PD patients (age, 10.6 +/- 4.7 years) . Kt/V correlated inversely with the age of the patient (HD, P < 0.004; PD, P < 0.0007), Although serum albumin level was not associated with dialysis adequacy in HD patients, there was a strong inverse relationship between a lbumin level and Kt/V in PD patients (P < 0.002), Hematocrit values were no t significantly different in the two groups (HD, 31.0% +/- 5.5% versus PD, 32.9% +/- 4.8%) and could not be correlated with weekly erythropoietin dose . Weekly erythropoietin dose was directly related to patient age in both gr oups (HD, P < 0.05; PD, P < 0.02), The weekly erythropoietin dosage needed to maintain the hematocrit was greater In HD patients (HD, 11,211 +/- 7,484 U versus PD, 3,790 +/- 1,968 U; P < 0.0001), We conclude that (1) smaller children in both groups tend to have a greater KW, (2) Kt/V greater than 2. 75 in PD patients may not improve nutrition per se and could result in incr eased albumin losses, and (3) erythropoietin dosing appears to correlate be st with patient size (age) rather than degree of anemia. (C) 2000 by the Na tional Kidney Foundation, Inc.