Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients.
BACKGROUND
The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKt/V) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents.


METHODS
Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKt/V was analyzed by the adult target (< versus > or = 1.2) and by intervals.


RESULTS
There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKt/V less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes.


CONCLUSIONS
Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fail to attain an spKt/V of 1.2 or greater. However, attaining an spKt/V in excess of 1.4 was not associated with greater benefit.
Gorman
Gregory
G
Department of Pediatrics and Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA. ggorman1@jhmi.edu
Furth
Susan
S
Hwang
Wenke
W
Parekh
Rulan
R
Astor
Brad
B
Fivush
Barbara
B
Frankenfield
Diane
D
Neu
Alicia
A
D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000592:standards*; D012189:Retrospective Studies; D016896:Treatment Outcome