Everything You Need to Know About Pediatric Dialysis

As Joe Cosgrove has already pointed out in previous articles, having kidney disease means that your kidneys are not properly working and are not able to filter blood anymore like they should. When this condition gets worst it is known as end-stage renal disease or ESRD and needs to be treated with dialysis.

Pediatric Emergency Department

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Most people think that ESRD only affects adults since their bodies are more deteriorated. However, ESRD also affects children. At least 1,462 children in the United States need to start dialysis treatment every year. Most of these children have congenital disorders (33%), have damaged kidneys due to glomerular disease (24,6%), or need to go on dialysis because they have glomerulonephritis (12,9%).

When we talk about adults, the most common causes of kidney failure are related to high blood pressure or diabetes. Nevertheless, when we talk about children, kidney disease is rarely related to those two conditions and it is often caused as a side effect of other treatments or because they have a hereditary condition that may affect their urinary tract.

Treating Children with ESRD in the United States

Every year over 10,000 children is treated for ESRD in the United States. Most of these children use hemodialysis as it is less invasive and easier to adapt to their bodies. This is how, every year 56 percent of these children are treated with hemodialysis and the rest just go under peritoneal dialysis, have kidney transplants or take alternative treatments.

At least 1,300 children are listed for kidney transplant every year. Over the past 20 years, this number seems to have grown dramatically since kidney diseases have become more popular among the U.S. population.

This is how treatments and medical procedures for children have also evolved. Technology has done major improvements and filtering membranes and catheters are now meant to be used in children, so their size is smaller, sometimes they are more resistant and flexible.

At first, there were many side effects related to hemodialysis in children. However, this seems to have been controlled over the past two decades. Now the morbidity rates during dialysis have considerably decreased and it is less common to experience seizures as a side effect during the treatment. The already mentioned medical advances have made it easier for children to deal with such an invasive procedure, so hypotensive episodes are quite uncommon nowadays.

A sensitive treatment

Saddest Pediatric Patient

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Two decades ago it was common for a dialysis patient to say that it was feeling pain or discomfort during the treatment. Keeping in mind that children’s bodies are more sensitive and fragile, dialysis procedures are less painful and discomforting today. The catheters used during the entire dialysis process are internal, making it impossible for children to remove it without helps. Besides, anesthetic creams are used to puncture the patient.

More sensitive and less invasive technologies have also been developed in order to reduce dramatic effects such as morbidity. These technologies can also reduce healthcare costs, making it simpler for the health care providers too.

Synthetic materials used in children are biocompatible and have a smaller size. This way, tubing and other processes related to pediatric dialysis are easier on the infant’s body. Diameter and length of tubes have been reduced so they can fit the patient’s veins. This way, the volume of filtered blood is going to be adequate both for having a successful a treatment and taking care of the child’s needs.

Machines used in pediatric dialysis are also special ones, so blood pumping is normal compared to the one that happens during the treatment adults get. Most dialysis machines used with children are designed to meet their needs and be used with pediatric patients.

The speed used when the blood is pumped in children is slower than in adults and needs to be kept that way since the capacity of patients to output blood is different and veins could be cloaked. For this reason, children need to be monitored during the entire dialysis session. Machines are always designed in a way that it is easier for healthcare providers to be in control of the dialysis process during the entire time.

Related: Is dialysis always recommendable?

Hemodialysis

Since children with ESRD will need to be exposed to dialysis for a long period, hemodialysis needs to be seen as a whole and not as a mere step of kidney disease therapy. Dialysis in children should be seen as a temporary thing. This happens because if the patient is feeling better then it will stop the treatment and if things complicate and the kidneys completely fail, then the pediatric patient will need to get a kidney transplant.

When patients have the chance to heal, then hemodialysis enables the chances for patients to improve their condition, while they can keep having a normal life. This treatment can often affect children’s physiologically when it is done in the long term, so it is recommended to give some kind of support to children while they are going through dialysis treatment.

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Some significant concepts about the Renal Compensation

As we have seen in different posts, the renal function is vital for human’s living. Through this process, the human body can filter the toxins and different substances from the blood, which cleans it and gives to people what they need to have a good quality living. If the renal system does not work adequately, a renal failure may occur. This problem could be defined in a few words like the impossibility for the body to process the different substances from the blood. A renal failure could be acute or chronic. Let’s see some of the most imperative concepts about this topic and some of its elements.

Acute renal failure

This renal failure is when the human body loses an important blood amount, or if for some reason a particular person ingests a toxic substance, causing the kidneys to fail and eventually to generate renal failures. In other words, an acute renal affectation could be generated by different external situations that change the normal functioning of the human body.

Chronic renal failure

This affectation is generated for some diseases or healthy hereditary problems, causing failures in the renal system. In some occasions, these issues are incurable and may require constant medical intervention, like dialysis or surgeries.

These two concepts are vital to understanding what the Renal Compensation is because they explain in a few words how the renal system works and which are its affectations. Having this clear, we can talk about other important concepts like the respiratory compensation, the respiratory acidosis, the respiratory alkalosis or the Glomerular Filtration Rate. However, it is important to understand firstly what the Renal Compensation is.

Renal Dialysis Technician

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The Renal Compensation concept

It could be defined as the process where the kidneys can regulate the acidity in the plasma, that is to say, that through the Renal Compensation, the human body can establish and control the pH in the blood.

When the plasma pH differs from 7.4, the body could suffer acidemia or alkalemia. Acidemia is when the blood acidity is lesser than 7.4, which means lack of acids which must be in the blood. Alkalemia occurs when the plasma pH is higher than 7.4 and means an excess of acid substances in the blood. When some of these problems occur, the human body can suffer respiratory or metabolic problems, and they could happen if there is a lack of Renal Compensation.

The Glomerular Filtration Rate

This concept refers to the filtered fluid volume in time by the human body, from the renal system to the Bowman capsule, which is part of the renal functioning where all the body substances to be excreted are filtered. Through this rate, the correct working of the renal system is measured, in other words, the Glomerular Filtration Rate is used for knowing if the kidneys and other elements from the renal circuit are operating in an adequate way.

Usually, the Glomerular Filtration Rate is measured through different techniques. Some of the most important are the measurement using inulin, the measurement with radioactive tracers, the estimation using the Cockcroft-Gault formula, the MDRD formula or the Starling Leonardo technique. Each one of these methods is developed to know and understand how the level of filtered fluids in the blood by the renal system, is working.

The Glomerular Filtration Rate is measured millimeters per minutes. In men, the adequate rate is 90 ± 14 millimeters per minute, in women is 60 ± 10 millimeters per minute.

hemodialysis_renal compensation

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Respiratory compensation

It is a medical method to change the blood acidity varying the respiratory rate. Put differently, the Respiratory compensation is a mechanism to alter the breathing way in the human body so the plasma pH can vary, depending on what the person needs.

The normal breathing rates in humans are measured in breaths per minute and are distributed like this:

In children, the normal rates are: from birth to six weeks of living, between 30 to 40 breaths per minute, from 6 months to three years, between 25 to 40 breaths per minute, from three to six years, 20 to 30 breaths per minute, and from six years to ten years, between 17 to 23 breaths per minute.

In adults, the rates are 12 to 18 breaths per minute, older than 65 years, between 12 to 28 breaths per minute, and older than 80 years, 10 to 30 breaths per minute.

We have seen some of the most used and recognized concepts in the Renal compensation process, but there are much more that must be understood to have a fuller picture of this term and its functioning. For example, other important notions about it are the Creatinine clearance, the Kt/V and its standardization, the Renal blood flow, the Ultrafiltration, the Filtration fraction, the PaH clearance, among other elements that are fundamental for the renal system understanding and its renal compensation.

Related: Dispelling The Most Common Myths About Kidney Disease by Joe Cosgrove

Dispelling The Most Common Myths About Kidney Disease

According to the Department of Health and Human Services, the prevalence of chronic kidney disease amongst the general population is around 14 percent. Out of the 661,000 Americans who have kidney failure, 468,000 approximately are undergoing dialysis treatment and 193,000 individuals live today with a functioning kidney transplant. These numbers can perhaps help us dismiss one of the most common myths surrounding kidney disease, and that is that this illness is rare and uncommon in today’s society.

The Stethoscope_joe cosgrove_medicine_Hemodialysis and Peritoneal Dialysis

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Today here in Joe Cosgrove’s Blog, we want to take some time to talk about some of the most common misconceptions behind kidney disease and what it means if you are diagnosed with renal failure. As it happens with many diseases, people are often misinformed and misguided about their expectations and their personal involvement into their own treatment and the expectancy of quality of life.

Kidneys are specialized organs in the body with the function of removing excess water and waste material from the blood and expelling them through urine. There are many reasons why kidneys may become damaged or suffer an overload of stress as their function is taxing and extremely important in context with how many systems of the human body operate.

Let’s take a look at some of the most common misconceptions behind kidney disease and its treatments.

You can easily tell if you have it.

The truth is that the large majority of people who have kidney disease are completely unaware of it. This happens because, in the early stages of the disease, symptoms are mostly nonexistent. The irony of this is that your best defense against kidney disease lays on early detection, but by the time the signs and symptoms are abundantly clear, then the disease is probably reaching a very advanced stage. Our recommendation for early detection is to get tested early if you are a person with a propensity for kidney disease due to your own health or if kidney disease is common in your family.   

There is little you can do to prevent it

There are many things you can do to prevent kidney disease before you get it and even after you have been diagnosed. A healthy diet and a regular dose of exercise goes a long way not only preventing from stressing your kidneys unnecessarily but also helping you with your overall health in general. Regular over the counter pain medication is particularly taxing on your kidneys. It is common for people to abuse this type of over the counter medicine because it is so easily available and because we have a bad habit of taking it for everything. Remember that your kidneys perform a difficult function so any help you can give them from your end will go a long way on making sure they remain healthy.

If you are urinating fine, then you are probably OK

While changes in your urine and in the way your body reacts when you are peeing are the most common indicators of kidney health, they are not the only signals when something is wrong. Even if your kidneys are damaged, they may continue to pass urine without any pain or changes in color while not filtering your blood properly. There are other symptoms like fatigue; swelling and joint pain that could raise a red flag and indicate you should probably get tested. Remember that a family history of kidney disease is a reason to be concerned if you have any doubts.

Doctor and Patient

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Dialysis is painful

Patients undergoing dialysis talk about the physical feeling more in the terms of “discomfort” rather than “pain”. While it may be a bit uncomfortable, the new technologies and the advances in health treatment can ensure that they pain you have to experience is minimal and only while you get used to the treatment, something that happens rather quickly. Pain is not something you should seriously consider when thinking about dialysis because it is a factor you can pretty much ignore as negligible.

Your diet is going to be strict and boring

This is a rumor born out of pure ignorance. You have to take control of your own health and talk with your nutritionist to come up with a change to your eating habits and find foods that can be good for you while being tasty and easy to prepare. Changes to your diet may be necessary but that doesn’t mean you have to sacrifice eating all the food you love. You just have to become smarter about the way you treat your body and be more conscious about what you eat. That is something we can all used a little bit of.

I cannot travel on dialysis

Patients on dialysis are able to travel normally as long as they play things out accordingly. It isn’t difficult to find treatment centers where you are going and schedule appointments in advanced. There are also great new alternatives that can let you take your equipment with you and receive the treatment wherever you want.