KidsMD Health Topics

Kidney Dialysis

  • One of the roles of your child’s kidneys is to act as a filter for the blood, making sure that it has the right balance of water and minerals. But if your child’s kidneys are unable to filter blood due to chronic kidney disease (CKD), and won’t recover normal kidney function, she will need either dialysis or a kidney transplant. If your child has Acute Kidney Injury, a course of dialysis can support her kidneys until her kidney function returns.

    Although around one-third of children with end-stage renal disease (ESRD) can go directly to a transplant, dialysis can help the others maintain a more stable health to ensure the most successful transplant possible.

    Your child’s doctor may also recommend a course of dialysis if:

    • She is waiting for a transplant and a suitable donor has yet to be identified
    • A kidney transplant is not yet the right option
    • She has just had an unsuccessful kidney transplant

    Dialysis at Boston Children’s Hospital

    At Boston Children’s your child will be treated in our seven-bed dialysis unit, designed especially for kids. Our dialysis nurses will do everything they can to make sure your child is comfortable during her treatments. In addition to the nurses, our unit also includes specially trained dieticians, tutors, Child Life specialists and pharmacists, making us the only full-service pediatric dialysis unit in New England. We perform about 3,500 chronic dialysis treatments per year.

     

     Transitioning from pediatric to adult care

     More than 9 million children in the United States are living with a chronic illness. Every year, 500,000 of these children turn 18. As they join their fellow adolescents in struggling to achieve optimal independence, they also face a serious issue they may not be prepared for: the transition of their medical care. Read Children’s tips for helping kids – and their families – make this key transition.

    Top ranking in dialysis management

    Boston Children’s has been named the highest-ranking pediatric hospital in dialysis management in the U.S. News and World Report's 2014 edition of America’s Best Children's Hospitals.

  • Filtering blood is one of several roles the kidneys play in your child’s health. Dialysis takes over that function for people with kidney failure, but they may also need to follow a special diet and take medicines to compensate for the other things that a fully functioning kidney may do, such as regulating certain vitamins and minerals. Here are other dialysis questions and answers.

    Does my child have to go to the hospital for dialysis?

    Not necessarily. There are two types of dialysis: peritoneal dialysis is performed at home; and hemodialysis is performed at the hospital or dialysis center.

    What’s the difference between peritoneal dialysis and hemodialysis?

    Peritoneal dialysis and hemodialysis use two different methods to reach the same goal – cleaning your child’s blood. Neither has been scientifically proven to be more effective than the other.

    Which type of dialysis is right for my child?

    Both types are effective treatments. In most cases, you can choose the type of dialysis that works best for your child’s and your family’s specific situation. Your child’s doctor will be happy to discuss your options with you.

    Please be assured that regardless of which option you choose, our staff will make sure that you have all the information and training you need to take care of your child.

    Peritoneal dialysis

    Peritoneal dialysis is a type of dialysis that can be performed at home. Most families who choose this option do continuous cyclic peritoneal dialysis (CCPD). This is an automatic process that uses a special dialysis machine, and it can be done while your child is asleep.

    How does peritoneal dialysis work?

    Peritoneal dialysis works by filling your child’s abdomen with a special solution called dialysate. In your child’s abdomen, the dialysate absorbs waste from your child’s blood the way water absorbs powdered iced tea mix. After the dialysate has absorbed the waste from your child’s blood, it drains out of the abdomen.

    The process of filling your child’s abdomen with dialysate, giving it time to absorb the waste from her blood, and draining out of her body is known as an “exchange.”

    How is peritoneal dialysis performed?

    First, your child’s surgeon will insert a soft, hollow tube (catheter) into her abdomen, near the navel. This is a permanent tube that will carry the dialysate in and out of her abdomen. It's not uncomfortable, and is easily hidden under clothes.

    Each night, as your child sleeps, the dialysis machine will automatically:

    1. Measure out the correct amount of dialysate
    2. Bring it to the correct temperature
    3. Transfer it to her abdomen through the catheter

    The dialysate will stay in her abdomen, cleaning and filtering blood, for a period of time determined by her doctor. Then it will drain back out through the catheter into a sterile drainage bag that is emptied each morning.

    This constitutes one exchange, and usually takes about an hour. Generally, around 10 exchanges are performed each night.

    Hemodialysis

    Hemodialysis is performed in a hospital or in a dialysis center.

    Your child is connected to a large machine called a dialyzer that takes blood out of her body in a continuous process, cleans and filters it, and returns it to her bloodstream. Only a very small amount of her blood is filtered at a time.

    Several weeks before your child’s first treatment, her doctor or another dialysis specialist will create an “access point” – an opening though which her blood is transported to the dialyzer and then back into her body after it has been cleaned. Depending on your child’s age and how long the course of dialysis is likely to be, his access point might be:

    • A catheter – a small, soft tube inserted into one of your child’s main blood vessels, often under her collarbone or in her neck
    • An arteriovenous (AV) fistula - a surgeon will connect two blood vessels in your child’s arm. This access point may be used for longer-term dialysis. This requires that the hemodialysis be performed through two tubes connected to needles that must be placed into the fistula, but it lessens the risk of infection that comes with using a catheter.

    How often would my child need to have hemodialysis performed?

    Hemodialysis is generally performed three times per week, and younger children may need it four times per week.

    How long does each session take?

    Each session lasts between three and four hours. If you are going to a dialysis center, it can be helpful to bring games or reading materials for your child. At Boston Children’s, our Child Life specialists and other dialysis staff members are there to make sure your child is comfortable and engage her in constructive play and/or provide tutoring as appropriate.

    Hemodialysis is much more efficient than peritoneal dialysis, which is why it does not need to be performed every day.

    Long-term outlook

    What’s the long-term outlook for my child?

    Unfortunately, chronic kidney disease is irreversible, and most children on dialysis will need a kidney transplant at some point. Thanks to efforts of Boston Children’s and other institutions, children under 18 are automatically moved to the top of the waiting list for donor kidneys.

    FAQ

    Q: Does my child have to go to the hospital for dialysis?

    A: Not necessarily. There are two types of dialysis: peritoneal dialysis is performed at home; and hemodialysis is performed at the hospital or at a dialysis center.

    Q: Which type of dialysis is right for my child?

    A: Both types are effective treatments. In most cases, you can choose the type of dialysis that works best for your child’s and your family’s specific situation. Your child’s doctor will be happy to discuss your options with you.

    Please be assured that regardless of which option you choose, our staff will make sure that you have all the information and training you need to take care of your child.

    Q: What’s the long-term outlook for my child?

    A: Unfortunately, chronic kidney disease is irreversible, and most children on dialysis will need a kidney transplant at some point. Thanks to efforts on the part of Children’s and other institutions, children under 18 are automatically moved to the top of the waiting list for donor kidneys.

    Questions to ask your doctor

    When you find out that your child needs to go on dialysis, you may feel overwhelmed with information. It can be easy to lose track of the questions you have.

    Lots of parents find it helpful to jot down their questions, that way when they talk to the child’s doctors, they can make sure all their concerns are addressed.

    If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

    Some of the questions you may want to ask include:

    • What factors should I take into consideration when choosing between peritoneal dialysis and hemodialysis?
    • What nutritional concerns should I be aware of when my child is on dialysis?
    • What are my child’s options if she needs to go to college or travel?

    Emergency preparedness

    It’s important to recognize that despite the best planning, an emergency may still occur. If this should happen, knowing what to do can make a stressful situation much easier to deal with.

    If you cannot leave your home, call Boston Children’s Dialysis Unit at (617) 355-5997 for instructions.

    Explore these online resources for helpful information and checklists about:

    More in-depth, detailed information is available here:

    • Planning for emergencies (National Kidney Foundation)
    • Prepping for an emergency (Renal Support Network)

    Boston Children’s emergency contact numbers:

    1. Dialysis Unit:  617-355-5997
    2. Operator:  617-355-6000 and ask for the Renal Fellow on call

    End Stage Renal Disease Act

    In 1972, Congress passed the End Stage Renal Disease Act, ensuring that Medicare will cover dialysis and kidney transplants for anyone who with end stage renal disease who is eligible for social security.

  • Boston Children’s Hospital is home to the world’s most extensive research enterprise at a pediatric hospital. In our End Renal Disease Stage Program—which includes the dialysis unit and our Kidney Transplant Program—our treatment is informed by our research.

    We also have a great number of partnerships with top research, biotech and health care organizations and we work together to improve kids’ health.

    Our Transplant Research Center (TRC) provides a rich environment for collaboration of scientists and physicians in the areas of transplantation and immunology.

    If your child has end-stage renal disease, dialysis can filter his blood, but not take over the other roles of the kidney, such as regulating the amounts of some important vitamins and minerals released into the bloodstream and controlling blood pressure. For that, your child needs to take medication and follow a special diet. Our researchers are currently involved in several clinical trials to assess the safety and efficacy of medications aimed at fulfilling this pharmaceutical component of treating end-stage renal disease.

    We’re committed to developing better anti-rejection medication with the goal of more successful transplants and fewer side effects.

    We currently participate in more NIH-sponsored pediatric kidney transplant research studies than any other program in the nation.

  • Nephrology

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115

     617-355-6129

     

     

    Kidney Transplant Program

    Boston Children's Hospital
    300 Longwood Avenue
    Farley 4
    Boston MA 02115

     617-355-7636

    fax: 617-730-0342

     

    End-Stage Renal Disease Program


    Boston Children's Hospital
    300 Longwood Avenue, Fegan 5
    Farley-4th Floor
    Boston, MA 02115

    617-355-7636

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