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Background and objectives Chronic kidney disease is a persistent chronic health condition commonly seen in pediatric nephrology programs. Our study aims to evaluate the sensitivity of the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric instrument to indicators of disease severity and activity in pediatric chronic kidney disease. Methods This cross sectional study included 233 children 817 years old, with chronic kidney disease from 16 participating institutions in North America. Disease activity indicators, including hospitalization in the previous 6 months, edema, and number of medications consumed daily, as well as disease severity indicators of kidney function and coexisting medical conditions were captured. PROMIS domains, including depression, anxiety, social-peer relationships, pain interference, fatigue, mobility, and upper extremity function, were administered via web-based questionnaires. Absolute effect sizes (AES) were generated to demonstrate the impact of disease on domain scores. Four children were excluded because of missing glomerular filtration rate (GFR) estimations. Results Of the 229 children included in the final analysis, 221 completed the entire PROMIS questionnaire. Unadjusted PROMIS domains were responsive to chronic kidney disease activity indicators and number of coexisting conditions. PROMIS domain scores were worse in the presence of recent hospitalizations (depression AES 0.33, anxiety AES 0.42, pain interference AES 0.46, fatigue AES 0.50, mobility AES 0.49), edema (depression AES 0.50, anxiety AES 0.60, pain interference AES 0.77, mobility AES 0.54) and coexisting medical conditions (social peer-relationships AES 0.66, fatigue AES 0.83, mobility AES 0.60, upper extremity function AES 0.48). Conclusions The PROMIS pediatric domains of depression, anxiety, social-peer relationships, pain interference, and mobility were sensitive to the clinical status of children with chronic kidney disease in this multi-center cross sectional study. We demonstrated that a number of important clinical characteristics including recent history of hospitalization and edema, affected patient perceptions of depression, anxiety, pain interference, fatigue and mobility. The PROMIS instruments provide a potentially valuable tool to study the impact of chronic kidney disease. Additional studies will be required to assess responsiveness in PROMIS score with changes in disease status over time. Keywords Patient reported outcomes * Quality of life * Transplant * End stage kidney disease * Chronic kidney disease * Pediatrics * Children, Introduction Individuals with chronic kidney disease represent a growing population in adult and pediatric practices. This has resulted in a drive to optimize patient care and outcomes [1]. Chronic kidney [...]

Background Cardiovascular disease is the leading cause of increased mortality for adolescents with advanced kidney disease. The quality of preventive cardiovascular care may impact long-term outcomes for these patients. Methods We reviewed the records of 196 consecutive adolescents from eight centers with pre-dialysis chronic kidney disease, on dialysis or with a kidney transplant, who transferred to adult-focused providers. We compared cardiovascular risk assessment and therapy within and across centers. Predictors of care were assessed using multilevel models. Results Overall, 58 % (range 44-86 %; p=0.08 for variance) of five recommended cardiovascular risk assessments were documented. Recommended therapy for six modifiable cardiovascular risk factors was documented 57 % (26-76 %; p=0.09) of the time. Of these patients, 30 % (n=59) were reported to go through formal transition which was independently associated with a 21 % increase in composite cardiovascular risk assessment (p Conclusions Adolescents with kidney disease receive suboptimal preventive cardiovascular care, that may contribute to their high risk of future cardiovascular mortality. A great opportunity exists to improve outcomes for children with kidney disease by improving the reliability of preventive care that may include formal transition programs. Keywords Cardiovascular disease * Transition * Quality . Chronic kidney disease * Kidney transplantation * Dialysis, Introduction Outcomes for children with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have improved, with an increasing number surviving well into adulthood [1, 2]. Unfortunately, many of these [...]

The main aim of this study was to compare the response to trivalent inactivated influenza vaccine in children who received a kidney transplant and were on steroid-free versus steroid-based immunosuppression. Groups: 1. Kidney transplant recipients on steroid-free immunosuppression (n=27); 2. Kidney transplant recipients on steroid-based immunosuppression (n=39); 3. Healthy controls (n=21). Hemagglutination inhibition titers against 2007-2008 A/H1N1 and A/H3N2 and B strains were measured before and 8 weeks postvaccination. Postvaccination geometric mean titers to A/H1N1 were significantly lower among both transplant groups than controls (p=0.025 and 0.015, respectively). Postvaccination titers to H3N2 and B strains were not statistically different between groups. Proportions of participants developing seroprotection were not different among groups. Both kidney transplant groups seroconverted less than controls for A/H1N1 (p=0.0002) and were no different from controls for B. For A/H3N2, the steroid-free group had the weakest seroconversion (p=0.008), possibly due to mycophenolate-enhanced exposure and a younger age. Overall, children after kidney transplantation demonstrated a good serologic response to the inactivated influenza vaccine although somewhat lower than controls. Steroid-free immunosuppression did not seem to present an advantage in antibody response. Data on inactivated influenza vaccine safety and efficacy was collected and demonstrated absence of acute rejection or laboratory-proven influenza for 6 months postvaccination. Keywords Influenza * Vaccination * Kidney * Transplantation * Children, Introduction Influenza A and B are the two virus types that cause human disease [1]. Influenza A viruses are additionally categorized into subtypes based on two surface antigens: hemagglutinin and [...]

Bacterial peritonitis is a major cause of morbidity in pediatric peritoneal dialysis (PD) patients and can lead to catheter removal, hospitalizations, peritoneal membrane dysfunction, and sepsis. The goal of this prospective study was to determine whether the incidence of peritonitis had improved over time and what practice patterns influenced peritonitis. Two cohorts of PD patients within the End-stage Renal Disease (ESRD) Networks 9/10 and who were Keywords Peritonitis * Peritoneal dialysis * Catheter infections * End-stage renal disease * Children, Introduction Bacterial peritonitis is a major cause of morbidity in pediatric peritoneal dialysis (PD) patients and in many cases leads to catheter removal, hospitalizations, peritoneal membrane dysfunction, sepsis, and possibly [...]

Abstract Cross-sectional studies have demonstrated that left ventricular hypertrophy (LVH) is common in children on maintenance dialysis. We report the echocardiogram results of 17 children from seven centers in the [...]

Access failure is a significant cause of morbidity and mortality in hemodialysis patients. Routine monitoring of arteriovenous (AV) fistulas and grafts could increase access longevity. Dynamic venous pressure monitoring is a surveillance test advocated to detect early signs of vascular thrombosis. Venous pressure measurements obtained, per DOQI recommendations, in children undergoing hemodialysis with an AV fistula or graft were reviewed. Baseline venous pressures were established by calculating the mean of venous pressures obtained without an antecedent thrombosis. A paired t-test was performed comparing mean baseline pressure measurements with pressures immediately preceding each thrombosis episode. Since some patients had multiple thrombosis episodes, the assumption of independence was not met. A second paired t-test was performed comparing mean baseline pressures with the mean pressure measurement per individual, obtained immediately preceding a thrombosis episode; 335 venous pressures were collected in ten pediatric patients. Eighteen thromboses occurred in five patients, in whom a total of 241 venous pressures were measured. Venous pressures did not correlate with thrombotic events (P = 0.4284). Specific thrombotic events for each patient were correlated with mean patient-specific venous pressures and showed no correlation (P = 0.3229). Dynamic venous pressure monitoring is not an adequate predictor of access thrombosis in pediatric patients. Access failure is a significant cause of morbidity and mortality in hemodialysis patients. Routine monitoring of arteriovenous (AV) fistulas and grafts could increase access longevity. Dynamic venous pressure monitoring is a surveillance test advocated to detect early signs of vascular thrombosis. Venous pressure measurements obtained, per DOQI recommendations, in children undergoing hemodialysis with an AV fistula or graft were reviewed. Baseline venous pressures were established by calculating the mean of venous... [ABSTRACT FROM AUTHOR]