321 aspects and the impact on clinical decision making and targeted outcomes is required to pro vide the best outcome In numerous countries with major limitations of healthcare budgets and inadequate[.]
18 Remote Patient Monitoring in Peritoneal Dialysis aspects and the impact on clinical decision- making and targeted outcomes is required to provide the best outcome In numerous countries with major limitations of healthcare budgets and inadequate or even missing dialysis options, in countries with shortage of medical staff, and in those where patients face very long distances to the dialysis centers, RPM should be an important mean to increase PD implementation Particular attention has to be paid on how virtual communication and RPM will transform patient care Effective communication relies on the two-way exchange of information, verbal and non-verbal clues, and the ability to connect with people and gain their trust Non-verbal clues apparent when communicating face to face may be missed; subtle signs of families not coping may be only detectable during personal communication The human element, the “care” element of medicine, may be altered or even lost in digitally enhanced care pathways This unintended consequence needs to be investigated and addressed Until then RPM practices need to be adopted within clear boundaries interspersed with frequent opportunities of face-to-face interaction for scrutiny and reassurance Up to now, RPM has mainly been used as an adjunct to established care At present, the positive and sometimes even enthusiastic communications of the pediatric centers applying RPM in children on chronic PD are encouraging References Jaar BG, Plantinga LC, Crews DC, Fink NE, Hebah N, Coresh J, Kliger AS, Powe NR. Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: a prospective study BMC Nephrol 2009;10:3 Bakkaloglu SA, Borzych D, Soo Ha I, Serdaroglu E, Büscher R, Salas P, Patel H, Drozdz D, Vondrak K, Watanabe A, Villagra J, Yavascan O, Valenzuela M, Gipson D, Ng KH, Warady BA, Schaefer F, International Pediatric Peritoneal Dialysis Network Cardiac geometry in children receiving chronic peritoneal dialysis: findings from the International Pediatric Peritoneal Dialysis Network (IPPN) registry Clin J Am Soc Nephrol 2011;6(8):1926–33 Borzych D, Rees L, Ha IS, Chua A, Valles PG, Lipka M, Zambrano P, Ahlenstiel T, Bakkaloglu SA, 321 Spizzirri AP, Lopez L, Ozaltin F, Printza N, Hari P, Klaus G, Bak M, Vogel A, Ariceta G, Yap HK, Warady BA, Schaefer F, International Pediatric PD Network (IPPN) The bone and mineral disorder of children undergoing chronic peritoneal dialysis Kidney Int 2010;78(12):1295–304 Chua AN, Warady BA. Adherence of pediatric patients to automated peritoneal dialysis Pediatr Nephrol 2011;26(5):789–93 Rosner MH, Lew SQ, Conway P, Ehrlich J, Jarrin R, Patel UD, Rheuban K, Robey RB, Sikka N, Wallace E, Brophy P, Sloand J. Perspectives from the kidney health initiative on advancing technologies to facilitate remote monitoring of patient self-care in RRT. Clin J Am Soc Nephrol 2017;12(11):1900–9 Wallace EL, Rosner MH, Alscher MD, Schmitt CP, Jain A, Tentori F, Firanek C, Rheuban KS, Florez- Arango J, Jha V, Foo M, de Blok K, Marshall MR, Sanabria M, Kudelka T, Sloand JA. Remote patient management for home dialysis patients Kidney Int Rep 2017;2(6):1009–17 Olszewski AE, Daniel DA, Stein DR, McCulloch MI, Su SW, Hames DL, Wolbrink TA. Teaching pediatric peritoneal dialysis globally through virtual simulation Clin J Am Soc Nephrol 2018;13(6):900–6 Bernardini J, Piraino B. Compliance in CAPD and CCPD patients as measured by supply inventories during home visits Am J Kidney Dis 1998;31(1):101–7 Gallar P, Vigil A, Rodriguez I, Ortega O, Gutierrez M, Hurtado J, Oliet A, Ortiz M, Mon C, Herrero JC, Lentisco C. Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis J Telemed Telecare 2007;13(6):288–92 10 Edefonti A, Boccola S, Picca M, Paglialonga F, Ardissino G, Marra G, Ghio L, Parisotto MT. Treatment data during pediatric home peritoneal teledialysis Pediatr Nephrol 2003;18(6):560–4 11 Chand DH, Bednarz D. Daily remote peritoneal dialysis monitoring: an adjunct to enhance patient care Perit Dial Int 2008;28(5):533–7 12 Kirsch C, Mattingely-Scott M, Muszynski C, Schafer F, Weiss C. Monitoring chronically ill patients using mobile technologies IBM Syst J 2007;46(1):85–93 13 Berman SJ, Wada C, Minatodani D, Halliday T, Miyamoto R, Lindo J, Jordan PJ. Home-based preventative care in high-risk dialysis patients: a pilot study Telemed J E Health 2011;17(4):283–7 14 Farmer AJ, McSharry J, Rowbotham S, McGowan L, Ricci-Cabello I, French DP. Effects of interventions promoting monitoring of medication use and brief messaging on medication adherence for people with type diabetes: a systematic review of randomized trials Diabet Med 2016;33(5):565–79 15 Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote monitoring of patients with heart failure: an overview of systematic reviews J Med Internet Res 2017;19(1):e18 16 Marshall MR, Pierratos A, Pauly RP. Delivering home hemodialysis: is there still a role for real-time treatment monitoring? Semin Dial 2015;28(2):176–9 Part IV Hemodialysis Hemodialysis Vascular Access in Children 19 Michael Boehm, Deepa H. Chand, and Mary L. Brandt Background Considerations about the cause and prognosis of kidney failure and the modality of kidney replacement therapy (KRT) should be made before a vascular access decision is taken In general, kidney dysfunction necessitating KRT can be either acute or chronic With acute kidney injury (AKI), establishment of immediate adequate vascular access to accommodate a high-flow circuit is essential Long-term consequences must also be considered in case kidney function does not recover Typically, a central venous catheter (CVC) placed in the internal jugular vein is used on an emergency basis and for a relatively short duration In CKD, the patient has a few treatment options once endstage kidney disease (ESKD) is reached: (preemptive) kidney transplantation, peritoneal M Boehm (*) Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria e-mail: michael.boehm@meduniwien.ac.at D H Chand Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA M L Brandt Pediatric Surgery Department, Tulane University School of Medicine and Children’s Hospital of New Orleans, New Orleans, LA, USA dialysis, or hemodialysis Given the fact that many children triangulate between these modalities over the course of a lifetime, vein preservation is crucial and should be given consideration at the time of diagnosis [1, 2] Whether they have AKI requiring KRT or CKD, children should not be considered “small adults” Thus, taking into account medical, psychosocial, socioeconomic, and individual factors, the KRT modality and probability of transplant needs to be clarified before a decision on vascular access can be made Moreover, a critical issue for these patients is to provide adequate vascular access for current KRT requirements without compromising future potential access sites However, despite data showing this is not ideal, recent studies show that CVC remains the first vascular access in a large proportion of children with ESKD, even though they not undergo a consecutive transplantation within a few months [3–6] This underlines the essential importance of well-considered planning, as virtually all children with ESKD find themselves in the eternal cycle of kidney replacement therapy Unlike adults, children may have decades of hemodialysis This means that an access which is technically easy may not be the best choice since it may sacrifice other, more distal sites for future access This difference in surgical philosophy is why it is so important to develop a team with expertise in all aspects of care of children with kidney failure © Springer Nature Switzerland AG 2021 B A Warady et al (eds.), Pediatric Dialysis, https://doi.org/10.1007/978-3-030-66861-7_19 325 326 ein Preservation in Children V with CKD In a child with known CKD, vein preservation should start as soon as the diagnosis is made, even at CKD stage In many instances, referral to a pediatric nephrologist is not made until CKD has progressed to stages or For that reason, education regarding vein preservation is important for patients, their families, and the multidisciplinary healthcare team (including phlebotomy staff, nurses, pediatric nephrologists, primary care physicians, emergency room personnel, surgeons, anesthesiologists, or other providers) Early referral and physician education can improve access options and therefore avoid morbidity associated with CVC use and venous access in the patient’s arms, both of which can limit options for a later dialysis access (Fig. 19.1) [7–9] A single venipuncture or placement of an intravenous catheter into the cephalic vein at the age of years can render the vein useless at age 10, making permanent access creation at this site Fig 19.1 Example of posted vein preservation education in healthcare facility M Boehm et al impossible Ideally, venous catheters, if necessary, should be placed in the dorsum of the hand in order to protect the cephalic vein, particularly at the wrist and in the forearm If a central venous catheter is indicated for total parenteral nutrition or medication administration, the subclavian vein should be avoided The incidence of subclavian stenosis following insertion of a single-lumen, small-caliber percutaneous line is well known and can permanently affect outflow for future access Subclavian stenosis in adults has been shown to occur in 5/15 patients at 1 week, in 6/13 patients after 2–6 weeks, and in almost 50% of patients studied following catheter removal (Fig. 19.2) [10–13] Hemodialysis Vascular Access Choices and Outcomes In patients with advanced and progressing CKD in whom the decision for hemodialysis has been made, vascular access planning should be initiated 19 Hemodialysis Vascular Access in Children 327 Table 19.1 Advantages of hemodialysis vascular access in children: AVF versus CVC AVF Better access survival Higher patency Less interventions necessary Lower rates of related infections Lower morbidity and mortality rates Higher quality of life (e.g., activities like bathing and swimming) Fig 19.2 Subclavian vein stenosis following central venous catheter placement in the subclavian vein precludes forever the use of that extremity for HD access 6–12 months prior to the anticipated start of dialysis [8, 9] A chronic hemodialysis access can be obtained in children by creation of a primary arteriovenous fistula (AVF), placement of an arteriovenous synthetic graft (AVG), or use of a cuffed central venous catheter (CVC) [14–16] Ample evidence supports the concept of “fistula first”; whenever feasible, a primary fistula should be the access of choice [17, 18] However, the decision which access is best for an individual patient should be based on patient age and size, diagnosis, the likelihood of transplantation, the procedural risks, and the probability of long-term patency The advantages of AVF and CVC, respectively, are summarized in Table 19.1 [6, 8, 17, 18] The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-K/DOQI) guidelines recommend the creation of a permanent access in all children weighing more than 20 kg in whom transplantation is not imminent [19] The functional survival of a vascular access technique is usually assessed by the primary and secondary patency rates Primary patency is defined as the time from placement to thrombosis or the first required intervention The secondary or cumulative patency is the time interval until the access is abandoned [20, 21] AVFs provide the best vascular access option in long-term hemodialysis because of excellent primary Improved dialysis adequacy Lower costs and hospitalization rate CVC Access for very young children Acute vascular access for urgent dialysis Less risk of high-output cardiac failure No vascular steal phenomena Painless (no needles) For children with an expected kidney transplantation in a short term Easily to remove patency and low complication rates Several studies have demonstrated that quality of life for children is equivalent, if not better, in children with AVF as compared to children with CVC-based hemodialysis [17, 18] The European Society for Paediatric Nephrology (ESPN) Dialysis Working Group recently suggested that for children with ESKD in whom “a kidney transplant is deemed unlikely within the following 6 months a functioning AVF is appropriate” [9] Despite the data supporting the use of AVF as the first access, in a population-based study of European children commencing chronic hemodialysis between 2000 and 2013, 55.1% of children started dialysis with a CVC. Approximately 25% of these children subsequently underwent creation of an AVF. Pertinent to this discussion, most of these AVFs were created in the first 3 months after placement of the CVC (Fig. 19.3) [5] In the North American NAPRTCS consortium, 78.7% of pediatric HD patients used CVC as primary access compared to AVF (11.8%) and AVG (6.7%) [4] The 2019 report of the population- based USRDS database disclosed primary CVC use in even 87.6% of pediatric patients [3] These data were further confirmed on a global scale by a report of the International Pediatric Hemodialysis Network (IPHN) registry, with M Boehm et al 328 Hemodialysis (incident patients) n=713 AVF n=320 still on AVF: n=91 Graft: n=2 TX (LD): n=16 TX (DD): n=195 PD: n=1 Death: n=1 n=12 n=97 n=2 AVF n=99 still on AVF: n=36 CVC n=393 1st access still on CVC: n=92 n=12 CVC n=24 nd access still on CVC: n=4 TX (LD): n=1 TX (DD): n=8 PD: n=2 Death: n=0 TX (LD): n=4 TX (DD): n=53 PD: n=1 Death: n=1 n=1 n=5 AVF n=6 n=3 n=4 CVC n=7 rd access Fig 19.3 Hemodialysis vascular access in 713 incident pediatric hemodialysis patients reported to the ESPN/ ERA-EDTA registry The majority of patients started hemodialysis with a CVC, with 97 of these 393 children switching to AVF during follow-up (Modified from Ref [5]) 200 Number of placements Fig 19.4 Hemodialysis vascular access placements in 552 patients reported to the International Pediatric Hemodialysis Network (IPHN) registry, stratified by age In total 870 placements were reported (cuffed CVC, n = 628; AVF, n = 225; AVG, n = 17) (Modified from Ref [6]) TX (LD): n=52 TX (DD): n=82 Tx (unknown donor type):n=2 PD: n=44 Death: n=12 150 CVC AVF 100 AVG 50 15 CVC including superior dialysis efficacy, less access infections, and lower need for access replacement [6] Hence, there is a remarkable ... showing this is not ideal, recent studies show that CVC remains the first vascular access in a large proportion of children with ESKD, even though they not undergo a consecutive transplantation within... decades of hemodialysis This means that an access which is technically easy may not be the best choice since it may sacrifice other, more distal sites for future access This difference in surgical... with ESKD, even though they not undergo a consecutive transplantation within a few months [3–6] This underlines the essential importance of well-considered planning, as virtually all children