Dialysis therapy in end-stage renal disease

The prognosis for children on dialysis has improved significantly in the past two decades. Much of this improvement can be attributed to the realization that adequate nutrition is a critical element of dialysis therapy and long-term morbidity and mortality in the dialysis population are closely linked to the nutritional state. Recommendations for nutritional intake have been formulated for infants and children with end-stage renal disease that take into account not only the metabolic derangement but also the effect of the dialysis treatment itself on the gain and loss of nutrients. In addition, the relationship between nutritional intake and the “dose” of dialysis is becoming clearer. Increasing experience in pediatric dialysis is enabling better selection of the mode of dialysis for children of different ages. The realization that the permeability of the peritoneal membrane is different from individual to individual has led to customized dialysis prescriptions with a consequent increase in the efficacy of peritoneal dialysis. When combined with improvements in therapy of medical complications of chronic renal failure, including the availability of synthetic erythropoetin and growth hormone and the management of renal osteodystrophy, dialysis is becoming a fully-functional tool in the management of children with end-state renal disease.