End-Stage Renal Disease Program | Overview
The End-Stage Renal Disease Program at Boston Children's Hospital provides comprehensive care, including medical management, dialysis and transplantation, for children with end-stage renal disease. Our clinical staff includes a number of experts from various subspecialties who work as a team to deliver the most consistent and comprehensive care to each child we see.
End-stage renal disease (ESRD) is also known as chronic kidney failure. It occurs when a child’s kidney becomes progressively unable to perform its functions, such as cleaning waste and toxins from the blood and regulating the level of red blood cells the body produces. ESRD can be treated with dialysis or a kidney transplant.
Children in our program are seen in both the Dialysis Unit and pediatric Kidney Transplant Program here at Boston Children’s. Close collaboration between staff in these two programs ensures extensive knowledge and experience in kidney transplantation of infants and children.
Our comprehensive evaluation process involves consultations with many specialists, including surgeons, dialysis nurses, nutritionists, social workers and psychologists.
We are also closely integrated with the Boston Children’s Division of Nephrology, which offers a continuum of services, from diagnosis and treatment of renal disorders to pediatric dialysis and kidney transplantation.
We provide a continuum of care to patients, from infants to young adults, who have conditions that result in end-stage renal disease. The conditions we treat include congenital and familial disorders of kidney development and acquired diseases such as focal segmental glomerulosclerosis (FSGS) and lupus.
In addition to providing expert diagnosis and treatment, we plan individualized therapy for your child. Our goals include:
Preserving your child's growth and development by integrating schooling into her treatment plan
Collaborating with experts in other fields to help manage any complications that may arise, including bone disease, high blood pressure (hypertension), nerve damage and too few red blood cells (anemia)
Providing guidance on behavioral and financial issues
Assisting in arranging transportation and home support, including visiting nursing services when appropriate
Our Innovative Approach
The End-Stage Renal Disease Program at Boston Children’s Hospital is dedicated to providing expert diagnosis and treatment of every condition that results in chronic kidney (renal) failure in children. Our team works closely with specialists in other departments in the hospital to develop individualized care plans that meet each child’s medical needs.
The two most important parts of our treatment approach are dialysis and kidney transplantation.
What is dialysis?
When a child’s kidneys don’t function properly, dialysis is used to filter a child’s blood and maintain the right balance of water and minerals. We may recommend a course of dialysis when a child is waiting for a kidney transplant, when a transplant is not yet the right option or when a child has just had an unsuccessful kidney transplant.
There are two types of dialysis, both of which are used to filter toxins from the blood:
- Peritoneal dialysis can be performed at home and is gentle and untaxing on the body. In peritoneal dialysis, a thin plastic tube (catheter) fills the child’s abdomen with a special solution called dialysate. Dialysate removes waste products from the blood before being drained back out of the body, either at night or at regular intervals. This process is known as an “exchange”.
- Hemodialysis is performed at the hospital or at a dialysis center. In hemodialysis, a child is connected to a large machine called a dialyzer that takes blood out of the body, cleans and filters it and returns it to the body in a continuous process. Only a very small amount of blood is filtered at a time.
Our Dialysis Unit
Children who require dialysis are treated in our seven-bed Dialysis Unit, located on Farley 4 on the main campus in Boston.
Our dialysis unit is home to an experienced and caring staff of doctors, nurses, a dietitian, social worker and a Child Life specialist. Each member of our staff has specialized training in the care of children and young adults with kidney disease.
We offer hemodialysis Monday through Saturday from 7 a.m. to 7 p.m.
Our multidisciplinary team also oversees the training and supervises the provision of home-based peritoneal dialysis for families and patients choosing that that treatment option.
Learn more about kidney dialysis
Kidney transplants are performed when a child with severe end-stage kidney disease (ESRD) no longer responds to treatment. In a kidney transplant operation, a diseased kidney is replaced with a healthy one from another person.
Members of the Kidney Transplant Program at Boston Children’s provide comprehensive care to infants and children undergoing kidney transplantation. Ours is the only program in New England that is entirely focused on the care of children. Since the program’s inception in 1971, the team has performed more than 630 transplants.