Many Kids with Kidney Failure Don't Get Adequate "Dose" of Dialysis

Newswise — Thirty percent of children on hemodialysis don't receive a high enough "dose" of dialysis to make up for their lost kidney function, suggests a study in the November Journal of the American Society of Nephrology.

The risks of inadequate hemodialysis are higher in boys and in African-American children, according to research led by Dr. Mary B. Leonard of The Children's Hospital of Philadelphia.

The researchers collected data on 138 children, average age 11 years, receiving hemodialysis for kidney failure. The children were treated at 32 dialysis centers nationwide. Multiple methods were used to assess whether the children's dialysis "dose" was adequate to their needs.

Overall, hemodialysis was deemed adequate for 70 percent of children. In the remaining 30 percent, the dialysis dose did not meet recommended minimal requirements.

Several factors placed the children at risk for inadequate hemodialysis, including African-American race. Boys—who have higher rates of childhood kidney disease—were less likely to receive adequate dialysis than girls. Risk was also higher for children of larger size, based on body surface area.

Children treated at centers that did not routinely track a key measure of how well dialysis is working to eliminate toxins—known as the "Kt/V ratio"—were also less likely to receive adequate hemodialysis. The adequacy of dialysis was unaffected by the children's age, the type of kidney disease, and the size of the dialysis center. Even at leading U.S. pediatric centers, a substantial number of children received an inadequate dialysis dose.

Studies in adults have shown that clinical outcomes are strongly related to the dose of hemodialysis, but few similar studies have been done in children. A major reason for this is the small number of children who require dialysis—children account for less than one percent of all patients receiving hemodialysis for kidney failure.

The new results raise concern that some children with kidney failure aren't receiving the full treatment needed to replace their lost kidney function. This may be a particular problem for certain groups of children, including boys and larger children.

The finding that African-American children are also at risk of inadequate hemodialysis "raise[s] important concerns regarding barriers and adequate dialysis among black children," Dr. Leonard and her co-authors conclude. They call for efforts to identify and overcome these barriers, as well as to improve the monitoring of dialysis adequacy in children.