Cardiovascular calcifications in pediatric patients receiving maintenance dialysis

Background and objectivesData on recovery of kidney function in pediatric patients with presumed ESKD are scarce. We examined the occurrence of recovery of kidney function and its determinants in a large cohort of pediatric patients on maintenance dialysis in Europe.Design, setting, participants, & measurementsData for 6574 patients from 36 European countries commencing dialysis at an age below 15 years, between 1990 and 2014 were extracted from the European Society for Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association Registry. Recovery of kidney function was defined as discontinuation of dialysis for at least 30 days. Time to recovery was studied using a cumulative incidence competing risk approach and adjusted Cox proportional hazard models.ResultsTwo years after dialysis initiation, 130 patients (2%) experienced recovery of their kidney function after a median of 5.0 (interquartile range, 2.0–9.6) months on dialysis. Compared with patients with congenital anomalies of the kidney and urinary tract, recovery more often occurred in patients with vasculitis (11% at 2 years; adjusted hazard ratio [HR], 20.4; 95% confidence interval [95% CI], 9.7 to 42.8), ischemic kidney failure (12%; adjusted HR, 11.4; 95% CI, 5.6 to 23.1), and hemolytic uremic syndrome (13%; adjusted HR, 15.6; 95% CI, 8.9 to 27.3). Younger age and initiation on hemodialysis instead of peritoneal dialysis were also associated with recovery. For 42 patients (32%), recovery was transient as they returned to kidney replacement therapy after a median recovery period of 19.7 (interquartile range, 9.0–41.3) months.ConclusionsWe demonstrate a recovery rate of 2% within 2 years after dialysis initiation in a large cohort of pediatric patients on maintenance dialysis. There is a clinically important chance of recovery in patients on dialysis with vasculitis, ischemic kidney failure, and hemolytic uremic syndrome, which should be considered when planning kidney transplantation in these children.

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Audiology Service Models in a Family Physician Practice Setting

Perspectives on Audiology ◽

10.1044/poa6.1.24 ◽

2010 ◽

Vol 6 (1) ◽

pp. 24-32 ◽

Cited By ~ 2

Author(s):

Sridhar Krishnamurti

Keyword(s):

Pediatric Patients ◽

Practice Patterns ◽

Healthcare Delivery ◽

Direct Consequence ◽

Direct Access ◽

Practice Setting ◽

Pediatric Populations ◽

Family Practice Physicians ◽

Primary Focus ◽

Balance Problems

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

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