Identifying Important Outcomes for Young People With CKD and Their Caregivers: A Nominal Group Technique Study.

Rationale & Objective: Chronic kidney disease (CKD) has wide-ranging and long-term consequences for young people and their families. The omission of outcomes that are important to young people with CKD and their caregivers limits knowledge to guide shared decision making. We aimed to identify the outcomes that are important to young people with CKD and their caregivers.

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation.

Background: To evaluate changes in population characteristics and outcomes in a large single-center pediatric patient cohort treated with continuous renal replacement therapy (CRRT) over a 10 year course, coincident with multiple institutional practice changes in CRRT delivery.

Methods: A retrospective cohort study with comparative analysis of all patients treated from 2004 to 2013 with CRRT in the neonatal, pediatric, and cardiovascular intensive care units within a free-standing pediatric tertiary care hospital.

Results: Three hundred eleven total patients were identified, 38 of whom received concurrent treatment with extracorporeal membrane oxygenation.

Child and Parental Perspectives on Communication and Decision Making in Pediatric CKD: A Focus Group Study.

Background & Objectives: Effective communication and shared decision making improve quality of care and patient outcomes but can be particularly challenging in pediatric chronic disease because children depend on their parents and clinicians to manage complex health care and developmental needs. We aimed to describe the perspectives of children with chronic kidney disease (CKD) and their parents with regard to communication and decision making.

Study Design: Qualitative study.

Health-related quality of life functioning over a 2-year period in children with end-stage renal disease.

Background: Optimal care of the pediatric chronic kidney disease/end stage renal disease (CKD/ESRD) patient must now incorporate health-related quality of life (HRQOL) assessment and management.

Methods: This study reports the first data on longitudinal change in global (PedsQL(TM)4.0) and disease-specific (PedsQL(TM)3.

A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients.

Accurate dry weight assessment is difficult in pediatric hemodialysis patients but is essential to prevent chronic fluid overload, hypertension, and cardiovascular morbidity. A noninvasive monitoring (NIVM) of hematocrit-guided ultrafiltration algorithm was studied prospectively in 20 pediatric hemodialysis patients. The algorithm targeted the first 50% of total goal ultrafiltration to be removed during the first hour of dialysis with a maximum blood volume change of 8 to 12% per hour.

Surgical technique for peritoneal dialysis catheter placement in the pediatric patient: a North American survey.

In the present study, we surveyed 425 members of the American Pediatric Surgical Association and the Canadian Association of Pediatric Surgeons to identify prevalent operative techniques used in the placement of peritoneal dialysis catheters by pediatric surgeons. Our survey assessed catheter type, skin and fascial incision orientations, deep-cuff positions, exit-site directions, and omentectomy. We received responses from 156 surgeons (36.

Staff nurses' perceptions of the work environment in freestanding hemodialysis facilities.

While one suggested cause of the current nursing shortage is nurses' negative perceptions of the work environment, little is known of nephrology nurses' perceptions of the dialysis work environment. The purpose of this study was to assess the extent to which staff nurses who work in freestanding hemodialysis facilities rate the presence of organizational characteristics common to magnet hospitals in their current job. Study findings indicate that staff nurses in hemodialysis units identify several notable features of magnet hospitals in their work settings.

Acute and chronic inflammation in pediatric patients receiving hemodialysis.

Objectives: To assess chronic and acute inflammation in children receiving maintenance hemodialysis.

Study Design: To assess markers of acute inflammation, serum levels (ELISA) of the cytokines tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-10, and IL-6, 3 to 5 mL of serum was obtained from 13 pediatric patients (mean patient weight, 37.0+/-15.

Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis.

Minimal pediatric data describe hospitalization causes and associated costs for children who receive maintenance hemodialysis, and no data exist to evaluate methods to decrease hospitalization. In 1999, two common causes of hemodialysis patient hospitalization at Texas Children's Hospital were fluid overload/hypertension (FO/HTN) and vascular access thrombosis (VAT). Evaluated is the effect of two noninvasive monitoring programs, monitoring of hematocrit-guided ultrafiltration algorithm and vascular access flow using ultrasound dilution vascular access flow technology, on FO/HTN and VAT in the pediatric maintenance hemodialysis population.

Staff nurses' perceptions of the work environment in freestanding hemodialysis facilities.

While one suggested cause of the current nursing shortage is nurses' negative perceptions of the work environment, little is known of nephrology nurses' perceptions of the dialysis work environment. The purpose of this study was to assess the extent to which staff nurses who work in freestanding hemodialysis facilities rate the presence of organizational characteristics common to magnet hospitals in their current job. Study findings indicate that staff nurses in hemodialysis units identify several notable features of magnet hospitals in their work settings.

nPCR assessment and IDPN treatment of malnutrition in pediatric hemodialysis patients.

Very few pediatric studies have monitored nutritional status using normalized protein catabolic rate (nPCR) or treating protein-energy malnutrition (PEM) with intradialytic parenteral nutrition (IDPN). The current study compares nPCR with serum albumin as a marker for nutritional status and examines the effectiveness of IDPN treatment in three malnourished adolescent patients receiving chronic hemodialysis in a pediatric dialysis unit. All patients demonstrated reversal of weight loss and initiation of weight gain within 6 weeks of IDPN initiation.

Proactive monitoring of pediatric hemodialysis vascular access: effects of ultrasound dilution on thrombosis rates.

Background: Hemodialysis vascular access thrombosis (VAT) is a significant cause of morbidity for hemodialysis patients and results, in part, from decreased access flow potentially caused by venous outflow stenosis. We have previously shown ultrasound dilution (UD) to be a practical and reliable predictor of venous outflow in children receiving hemodialysis.

Methods: The current study is the first to our knowledge to assess the impact of a proactive UD monitoring program upon VAT in pediatric patients.