Children on Long-Term Dialysis in the United States: Findings From the 2005 ESRD Clinical Performance Measures Project
Received 5 June 2007; accepted 10 September 2007. published online 31 October 2007.
Background
The Centers for Medicare & Medicaid Services End-Stage Renal Disease Clinical Performance Measures (CPM) Project contains one of the largest databases of prevalent pediatric dialysis patients in the United States. Since 2005, the CPM Project has included not only children on long-term hemodialysis (HD) therapy, but also those on long-term peritoneal dialysis (PD) therapy. This study describes demographic and clinical characteristics and compares them between patients on HD and PD therapy.
Study Design
Cross-sectional.
Setting & Participants
Children aged 0 to younger than 18 years included within the 2005 End-Stage Renal Disease CPM Project.
Predictor
Demographic and clinical characteristics, with emphasis on dialysis modality.
Outcomes & Measurements
Achievement of values for hemoglobin, dialysis adequacy, and serum albumin as recommended by recent National Kidney Foundation-Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines and Recommendations.
Results
Of 1,453 patients examined, 692 received HD and 761 received PD. There was no significant difference by dialysis modality in the likelihood of having a mean hemoglobin level of 11 g/dL or greater; however, HD patients were significantly more likely to have a mean hemoglobin level less than 10 g/dL (19% versus 14% of PD patients; P = 0.02). Although statistically significant, the absolute difference in mean hemoglobin levels between patients receiving HD versus PD was small (11.4 versus 11.6 g/dL). Eighty-nine percent of patients receiving HD and 87% of patients receiving PD achieved the recommended modality-specific Kt/V (P = 0.4). Children receiving HD were more likely than those receiving PD to have a mean serum albumin level of 4.0/3.7 g/dL or greater (bromcresol green/bromcresol purple laboratory method): 46% versus 33% (P < 0.001).
Limitations
Because of study design, only associations can be described.
Conclusions
A significant number of children had hemoglobin, serum albumin, and/or Kt/V values outside the recommended targets. Future research is needed to better define the risk relationships of these predictors with morbidity and mortality in children on dialysis therapy, evaluate the benefit of treating to certain treatment targets, and understand reasons for failing to reach treatment targets in individual patients or patient groups.
1Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
2Office of Research, Development, and Information, Centers for Medicare & Medicaid Services, Baltimore, MD
3Department of Pediatrics, Emory School of Medicine, Atlanta, GA
4Department of Pediatrics, National Naval Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD
5Department of Pediatrics, University of Missouri, Kansas City, MO.
Address correspondence to Jeffrey J. Fadrowski, MD, MHS, Assistant Professor of Pediatrics, Johns Hopkins University School of Medicine, David M. Rubenstein Child Health Bldg, Rm 3055, 200 N Wolfe St, Baltimore, MD 21287.
ABSTRACT