title: [Referral to the pediatric dialysis unit -- the earlier the better?].
abstract: Whereas recent research has demonstrated clear evidence for beneficial effects of early referral to the nephrologist in chronic renal insufficiency in adults, no such data exist for the pediatric population. In this study, we therefore correlated patient age and residual renal function at first presentation to a specialized pediatric nephrologist with the extent of secondary uremic complications and the further course of renal function. From March 2003 until March 2004, 43 children (34 boys, aged 10.1 +/- 6.3 yrs) with congenital-urologic (n = 26), congenital-nephrologic (n = 13) or acquired (n = 4) renal diseases had been followed for 3.9 yrs (14 days to 17.5 yrs) at the Kinderdialyse Wien, with a residual renal function of 35 +/- 20.5 ml/min/1.73 m(2) at first presentation. With regards to uremic secondary complications, the majority of children exhibited involvement of at least two systems at first presentation. Thereafter, children with congenital diseases who were referred to the specialized pediatric nephrology unit within the first year of live demonstrated a significantly better course of residual renal function (1.8% vs -0.7%, p = 0.034) than children who were referred later. These data confirm recent registry reports on chronic renal insufficiency in children. Only about a third of the children of our population were presented to a specialized pediatric nephrology center within their first year of life (despite a congenital disease in 90% of them). Thus, therapeutic interventions might be currently offered at a delayed time point in the majority of children.
authors.affiliation: Kinderdialyse Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Wien, Osterreich.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Klaus
authors.initials: K
authors.lastname: Arbeiter
authors.forename: Thomas
authors.initials: T
authors.lastname: Müller
authors.forename: Niclas
authors.initials: N
authors.lastname: Raffelsberger
authors.forename: Jutta
authors.initials: J
authors.lastname: Falger
authors.forename: Egon
authors.initials: E
authors.lastname: Balzar
authors.forename: Christoph
authors.initials: C
authors.lastname: Aufricht
mesh_terms: D001317:Austria / Q000453:epidemiology; D002648:Child; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D009398:Nephrology; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome