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ABSTRACT: This study evaluates the long-term outcomes of infants with end stage renal disease (ESRD) who required initiation of chronic
peritoneal dialysis (PD) prior to 28days of age. Infants with ESRD present both ethical and technical challenges for pediatric
nephrologists and neonatologists. Recent advances in the medical management of ESRD in infants combined with improved infant
transplantation outcomes make it more likely that such infants can survive to successful kidney transplantation. We reviewed
all infants initiating PD for ESRD before 28days of age at the University of Minnesota Amplatz Children’s Hospital from 1995
to 2004 (n = 23). Overall 1 - and 5-year patient survival was 52 and 48%, respectively. Twelve children received kidney transplants
at a median age and weight of 1.12years and 9.5kg, respectively, with a 5-year graft survival rate of 83%. In summary, a
majority of infants requiring renal replacement therapy with PD in the first month of life achieve long-term survival with
a successful kidney transplant.
Pediatric Nephrology 04/2012; 24(10):2035-2039. · 2.52 Impact Factor
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[show abstract]
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ABSTRACT: This study evaluates the long-term outcomes of infants with end stage renal disease (ESRD) who required initiation of chronic peritoneal dialysis (PD) prior to 28 days of age. Infants with ESRD present both ethical and technical challenges for pediatric nephrologists and neonatologists. Recent advances in the medical management of ESRD in infants combined with improved infant transplantation outcomes make it more likely that such infants can survive to successful kidney transplantation. We reviewed all infants initiating PD for ESRD before 28 days of age at the University of Minnesota Amplatz Children's Hospital from 1995 to 2004 (n = 23). Overall 1 - and 5-year patient survival was 52 and 48%, respectively. Twelve children received kidney transplants at a median age and weight of 1.12 years and 9.5 kg, respectively, with a 5-year graft survival rate of 83%. In summary, a majority of infants requiring renal replacement therapy with PD in the first month of life achieve long-term survival with a successful kidney transplant.
Pediatric Nephrology 07/2009; 24(10):2035-9. · 2.52 Impact Factor
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ABSTRACT: Although albumin excretion rates have been related to cardiovascular morbidity and mortality in both diabetic and nondiabetic adults, little is known about the relation between albuminuria and either cardiovascular risk factors or the insulin resistance syndrome in adolescents. A normal range for albumin excretion in adolescents was established, correlations between albumin excretion and cardiovascular risk factors were evaluated, and albumin excretion in normal adolescents was compared with that in type 1 diabetes mellitus adolescents.
Albumin excretion rate was measured in 368 normal and 175 diabetic adolescents. Multiple regression analysis was used to predict the relation of age, sex, Tanner stage, body mass index, and systolic blood pressure to albumin excretion in both cohorts. In addition, correlations between albumin excretion and age, blood pressure, body mass index, lipids, and measurements of insulin resistance were performed in the normal adolescents.
Mean albumin excretion was significantly lower in normal adolescents (4.0 microg/min) than in type 1 diabetic adolescents (5.0 microg/min). Albumin excretion increased with age in diabetics. Albumin excretion did not significantly correlate with any measure of cardiovascular risk or insulin resistance but did significantly correlate with fasting insulin.
Albumin excretion rate is not related to insulin resistance or traditional cardiovascular risk factors in adolescence but is related to fasting insulin. Diabetic adolescents have increased albumin excretion compared with normal adolescents.
Clinical Journal of the American Society of Nephrology 07/2008; 3(4):998-1005. · 5.23 Impact Factor
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ABSTRACT: Transplantation is now the preferred treatment for children with end-stage kidney disease. But not all pediatric age groups have enjoyed the same success. The number of transplants in infants and young children has lagged behind the number in older children. One reason for this is the philosophy of some centers to maintain infants on dialysis until they reach some arbitrarily determined age, at which time they would undergo a transplant. If kidney transplantation is the therapy of choice for older children with renal failure, and equivalent results can be obtained in all age groups, why should it not be offered to these youngest patients? Our center's philosophy for many years has been not to restrict transplant based on size or age. We have performed over 50 kidney transplants in infant recipients, and have shown equivalent results to those obtained in older children. Important factors in obtaining a successful outcome include the use of adult kidneys from a living donor, careful attention to operative and perioperative care, and performing the transplant early or in a preemptive fashion. The latter allows for minimizing the negative impact of uremia on physical and neurologic development in infants.
Pediatric Transplantation 12/2007; 11(7):702-8. · 1.48 Impact Factor
