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Larry A Greenbaum - One of the best experts on this subject based on the ideXlab platform.
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vitamin d in incident nephrotic syndrome a midwest Pediatric Nephrology consortium study
Pediatric Nephrology, 2016Co-Authors: David T Selewski, Larry A Greenbaum, Patrick D Brophy, Ashton Chen, Ibrahim F. Shatat, Priya Pais, Pavel Geier, Raoul D. Nelson, Stefan G. Kiessling, Alejandro QuirogaAbstract:Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D. In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.
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Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study
Pediatric Nephrology, 2015Co-Authors: David T Selewski, Larry A Greenbaum, Patrick D Brophy, Ashton Chen, Ibrahim F. Shatat, Priya Pais, Pavel Geier, Raoul D. Nelson, Stefan G. Kiessling, Alejandro QuirogaAbstract:Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D
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the us Pediatric Nephrology workforce a report commissioned by the american academy of Pediatrics
American Journal of Kidney Diseases, 2015Co-Authors: William A Primack, Kevin E C Meyers, Suzanne Kirkwood, Holly Ruchross, Carrie L Radabaugh, Larry A GreenbaumAbstract:The US Pediatric Nephrology workforce is poorly characterized. This report describes clinical and nonclinical activities, motivations and disincentives to a career in Pediatric Nephrology, future workforce needs, trainee recruitment, and possible explanations for personnel shortages. An e-mail survey was sent in 2013 to all identified US-trained or -practicing Pediatric nephrologists. Of 504 respondents, 51% are men, 66% are US graduates, and 73% work in an academic setting. About 20% of trained Pediatric nephrologists no longer practice Pediatric Nephrology. Among the 384 respondents practicing Pediatric Nephrology full or part-time in the United States, the mean work week was 56.1±14.3 hours, with time divided between patient care (59%), administration (13%), teaching (10%), clinical research (9%), basic research (6%), and other medical activities (3%). Most (>85%) care for dialysis and transplantation patients. The median number of weeks annually on call is 16, and 29% work with one or no partner. One-third of US Pediatric nephrologists (n=126) plan to reduce or stop clinical Nephrology practice in the next 5 years, and 53% plan to fully or partially retire. Almost half the division chiefs (47%) report inadequate physician staffing. Ongoing efforts to monitor and address Pediatric Nephrology workforce issues are needed.
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gaining the patient reported outcomes measurement information system promis perspective in chronic kidney disease a midwest Pediatric Nephrology consortium study
Pediatric Nephrology, 2014Co-Authors: David T Selewski, Maria E Ferris, John D. Mahan, Susan F Massengill, Jonathan P Troost, Larysa Wickman, Kassandra L Messer, Emily Herreshoff, Corinna Bowers, Larry A GreenbaumAbstract: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.
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clinical Pediatric Nephrology
1992Co-Authors: Kanwal K Kher, William H Schnaper, Larry A GreenbaumAbstract:Clinical Pediatric Nephrology / , Clinical Pediatric Nephrology / , کتابخانه دیجیتال دانشگاه علوم پزشکی گلستان
Maria E Ferris - One of the best experts on this subject based on the ideXlab platform.
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The global Pediatric Nephrology workforce: a survey of the International Pediatric
2020Co-Authors: Dorey Glenn, Sophie Ocegueda, Meaghan Nazareth, Yi Zhong, Adam Weinstein, William A Primack, P Cochat, Maria E FerrisAbstract:Background: The global Pediatric Nephrology workforce is poorly characterized. The objectives of our study were to assess Pediatric nephrologists’ perceptions of the adequacy of the Pediatric Nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements were also queried. Methods: A 17-question web-based survey comprised of 14 close-ended and 3 open-ended questions was e-mailed to members of the International Pediatric Nephrology Association. Quantitative and qualitative analyses were performed. Results: We received 341 responses from members of the International Pediatric Nephrology Association from 71 countries. There was a high degree of overall perceived workforce inadequacy with 67 % of all respondents reporting some degree of shortage. Perceived workforce shortage ranged from 20 % in Australia/New Zealand to 100 % in Africa. Respondents from Africa (25 %) and North America (22.4 %) reported the greatest difficulty recruiting fellows. Respondents from Australia/New Zealand (53.3 %) and Latin America (31.3 %) reported the greatest perceived difficulty finding jobs as Pediatric nephrologists after training. Low trainee interest, low salary, lack of government or institutional support, and few available jobs in Pediatric Nephrology were the most frequently reported obstacles to fellow recruitment and job availability. Conclusions: Globally, there is a high level of perceived inadequacy in the Pediatric Nephrology workforce. Regional variability exists in perceived workforce adequacy, ease of recruitment, and job acquisition. Interventions to improve recruitment targeted to specific regional barriers are suggested.
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developing a research mentorship program the american society of Pediatric Nephrology s experience
Frontiers in Pediatrics, 2019Co-Authors: Tetyana L Vasylyeva, Maria E Ferris, Kimberly J Reidy, David S Hains, Jacqueline Ho, Lyndsay A Harshman, Tammy Mcloughlin Brady, Daryl M Okamura, Dmitry V Samsonov, Scott E. WenderferAbstract:Background: Mentor-mentee relationships provide support and guidance for the development of an academic physician’s research career. The experience in mentorship program implementation is valuable for medical fields in providing research opportunities to young faculty. Methods: The American Society of Pediatric Nephrology (ASPN) established a research mentorship program to a) assist with matching of appropriate mentor-mentee pairs and b) establish metrics for desirable mentor-mentee outcomes with two independent components: 1) the grants review workshop, a short-term program providing mentor feedback on grant proposals, and 2) the longitudinal program, establishing long-term mentor-mentee relationships. Regular surveys of both mentors and mentees were reviewed to evaluate and refine the program. Results: Twelve mentees and 17 mentors participated in the grant review workshop and 19 mentees were matched to mentors in the longitudinal program. A review of NIH RePORTER data indicated that since 2014, 13 NIH grants have been awarded. Mentees in the longitudinal program reported that the program helped most with identifying an outside mentor, improving grant research content, and with general career development. Mentors perceived themselves to be most helpful in assisting with overall career plans. Email communications were preferred over phone or face-to-face communications. Mentees endorsed strong interest in staying in touch with their mentors and 100% of mentors expressed their willingness to serve in the future. Conclusion: This mentorship program was initiated and supported by a relatively small medical society and has shown early success in cultivating mentoring relationships for a future generation of clinician-scientists and could serve as a model.
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the global Pediatric Nephrology workforce a survey of the international Pediatric Nephrology association
BMC Nephrology, 2016Co-Authors: Dorey Glenn, Sophie Ocegueda, Meaghan Nazareth, Yi Zhong, Adam Weinstein, William A Primack, P Cochat, Maria E FerrisAbstract:Background The global Pediatric Nephrology workforce is poorly characterized. The objectives of our study were to assess Pediatric nephrologists’ perceptions of the adequacy of the Pediatric Nephrology workforce, and understand regional challenges to fellow recruitment and job acquisition. Perceptions regarding optimal length of training and research requirements were also queried.
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wanted Pediatric nephrologists why trainees are not choosing Pediatric Nephrology
Renal Failure, 2014Co-Authors: Maria E Ferris, Edward G.a. Iglesia, Zion Ko, Ahinee Amamoo, John D. Mahan, Tejas Desai, Keisha Gibson, Kenar D. Jhaveri, William A PrimackAbstract:AbstractA workforce crisis for many Pediatric specialties, particularly Nephrology, is due to growing retirement rates, attrition during training, and retention difficulties. To obtain specific information regarding Pediatric Nephrology trainee shortages, we administered two cross-sectional surveys to non-renal Pediatric subspecialty fellows and Pediatric Nephrology program directors. We characterized the fellows' experiences with Nephrology and the program directors' experiences with their fellows as well as their outcomes in the last 10 years. We analyzed responses from 531 non-renal fellows (14.4% response rate). Overall, 317 (60%) fellows rated Nephrology as difficult, particularly women (65.4% vs. 49.5%, p < 0.001), with American women medical graduates rating Nephrology as more difficult compared to all others (p = 0.001). More men than women (24% vs. 8%, p < 0.001) considered the monetary benefit as not adequate. Program directors (25; 64% response rate) represented 57% of all USA fellows in traini...
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Wanted: Pediatric nephrologists! — why trainees are not choosing Pediatric Nephrology
Renal Failure, 2014Co-Authors: Maria E Ferris, Edward G.a. Iglesia, Zion Ko, Ahinee Amamoo, John D. Mahan, Tejas Desai, Keisha Gibson, Kenar D. Jhaveri, William A PrimackAbstract:AbstractA workforce crisis for many Pediatric specialties, particularly Nephrology, is due to growing retirement rates, attrition during training, and retention difficulties. To obtain specific information regarding Pediatric Nephrology trainee shortages, we administered two cross-sectional surveys to non-renal Pediatric subspecialty fellows and Pediatric Nephrology program directors. We characterized the fellows' experiences with Nephrology and the program directors' experiences with their fellows as well as their outcomes in the last 10 years. We analyzed responses from 531 non-renal fellows (14.4% response rate). Overall, 317 (60%) fellows rated Nephrology as difficult, particularly women (65.4% vs. 49.5%, p
Guido Filler - One of the best experts on this subject based on the ideXlab platform.
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Are Canadian Pediatric Nephrology patients really overweight
Clinical Nephrology, 2012Co-Authors: Abeer Yasin, Andréanne Benidir, Guido FillerAbstract:To assess the influence of height age and short stature on BMI z-scores in children with chronic kidney disease (CKD) in view of the pandemic increase of childhood obesity. Pediatric Nephrology patients older than 2 years of age from 2 tertiary centers in Ontario and age- and gender matched controls from a local reference population. We estimated height, weight and body mass index (BMI) z-scores of 705 Nephrology patients (319 female) and 4,196 controls aged 2.01 - 19.92 years with chronological and height-adjusted age (corresponding age for a given height plotted on the 50th percentile). The National Health and Nutrition Examination Survey (NHANES III) was used for the z-score Estimation. Chronological age-based patient weight z-scores were significantly heavier than in the NHANES data (median weight z-score +0.29, BMI z-score +0.51; significantly non-zero), not significantly different from height-adjusted age-based BMI z-score (+0.51). The children with kidney problems were shorter (-0.10 SD) than controls. The proportion of overweight Nephrology patients was similar to matched controls and BMI z-score diminished with worsening GFR.
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adherence to waiting time targets for Pediatric Nephrology clinic referrals
Pediatric Nephrology, 2010Co-Authors: Maria Radina, Ajay P. Sharma, Abeer Yasin, Guido FillerAbstract:Waiting times for specialist consultation have not been adequately studied, especially in the Pediatric population. The aim of this study was to determine the extent to which Pediatric Nephrology subspecialty clinic referral waiting times are adhered to with regard to previously determined access targets. Referrals to the Pediatric Nephrology clinics at Children’s Hospital, London, Ontario, Canada, received between October 2007 and November 2008 were retrospectively analyzed. Appointment schedule was allotted by a nephrologist based on the patient’s presenting complaint, reported in the referral, in accordance with the previously determined access targets. Adherence to access targets was assessed by the actual clinic visit. There were a total of 250 referrals during the timeframe studied. The median waiting time was 73 (range 0–193) days. Overall, 64% (159/250) of patients met their access target. The median time that patients waited over their access target was 6 (range 0–78) days. Of the patients who did not meet their access targets, 31% (28/91) exceeded their target by 20% or more. Office handling was a component for patients with access target <1 week, whereas availability of clinic space was the main reason for nonadherence to access targets.
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Adherence to waiting-time targets for Pediatric Nephrology clinic referrals
Pediatric Nephrology, 2009Co-Authors: Maria Radina, Ajay P. Sharma, Abeer Yasin, Guido FillerAbstract:Waiting times for specialist consultation have not been adequately studied, especially in the Pediatric population. The aim of this study was to determine the extent to which Pediatric Nephrology subspecialty clinic referral waiting times are adhered to with regard to previously determined access targets. Referrals to the Pediatric Nephrology clinics at Children’s Hospital, London, Ontario, Canada, received between October 2007 and November 2008 were retrospectively analyzed. Appointment schedule was allotted by a nephrologist based on the patient’s presenting complaint, reported in the referral, in accordance with the previously determined access targets. Adherence to access targets was assessed by the actual clinic visit. There were a total of 250 referrals during the timeframe studied. The median waiting time was 73 (range 0–193) days. Overall, 64% (159/250) of patients met their access target. The median time that patients waited over their access target was 6 (range 0–78) days. Of the patients who did not meet their access targets, 31% (28/91) exceeded their target by 20% or more. Office handling was a component for patients with access target
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Pediatric Nephrology patients are overweight 20 years experience in a single canadian tertiary Pediatric Nephrology clinic
International Urology and Nephrology, 2007Co-Authors: Guido Filler, Silvia Mansur Reimao, Anusha Kathiravelu, Joanne Grimmer, Janusz Feber, Alfred DrukkerAbstract:Background Obesity is an independent risk factor for chronic kidney disease (CKD). We compared the body composition of Pediatric Nephrology patients with that of the general child population over 2 decades.
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Changing trends in the referral patterns of Pediatric Nephrology patients.
Pediatric Nephrology, 2005Co-Authors: Guido Filler, Alfred Drukker, Robert P. Payne, Elaine Orrbine, Tammy Clifford, Peter N. MclaineAbstract:This study investigates the changing referral patterns of young patients to a tertiary Pediatric Nephrology center with a well-defined catchment area over two consecutive 8.5-year periods. We paid special attention to the known increase of obesity and diabetes mellitus in childhood. Demographic data (site of residence, height, weight, gender and renal diagnosis) were collected on 6,154 children aged 0–19 years, referred as in- and outpatients to the Children’s Hospital of Eastern Ontario for nephrological work-up. Body mass index (BMI) Z-scores were calculated on the basis of data from the National (USA) Center for Health Statistics (2000). In 6,124 (99.5%) patients a final renal diagnosis could be made, allowing calculation of the incidence of a variety of renal diseases in Pediatric patients, data that are not readily available. BMI increased significantly over the years, with a Z-score that rose from a median of +0.20 to +0.32 in the two 8.5-year study periods (p
David T Selewski - One of the best experts on this subject based on the ideXlab platform.
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vitamin d in incident nephrotic syndrome a midwest Pediatric Nephrology consortium study
Pediatric Nephrology, 2016Co-Authors: David T Selewski, Larry A Greenbaum, Patrick D Brophy, Ashton Chen, Ibrahim F. Shatat, Priya Pais, Pavel Geier, Raoul D. Nelson, Stefan G. Kiessling, Alejandro QuirogaAbstract:Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D < 20 ng/ml at diagnosis. Twenty-seven (53 %) had 25(OH)D < 20 ng/ml at follow-up. Fourteen (28 %) children were steroid resistant. Univariate analysis showed that children prescribed vitamin D supplements were less likely to have 25(OH)D deficiency at follow-up (OR 0.2, 95 % CI 0.04, 0.6). Steroid response, age, and season did not predict 25(OH)D deficiency. Multivariable linear regression modeling showed higher 25(OH)D levels at follow-up by 13.2 ng/ml (SE 4.6, p < 0.01) in children supplemented with vitamin D. In this incident idiopathic NS cohort, all children at diagnosis had 25(OH)D deficiency and the majority continued to have a deficiency at 2–4 months. Supplemental vitamin D decreased the odds of 25(OH)D deficiency at follow-up, supporting a role for supplementation in incident NS.
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Vitamin D in incident nephrotic syndrome: a Midwest Pediatric Nephrology Consortium study
Pediatric Nephrology, 2015Co-Authors: David T Selewski, Larry A Greenbaum, Patrick D Brophy, Ashton Chen, Ibrahim F. Shatat, Priya Pais, Pavel Geier, Raoul D. Nelson, Stefan G. Kiessling, Alejandro QuirogaAbstract:Cross-sectional studies of children with prevalent nephrotic syndrome (NS) have shown 25-vitamin D (25(OH)D) deficiency rates of 20–100 %. Information on 25(OH)D status in incident patients or following remission is limited. This study aimed to assess 25(OH)D status of incident idiopathic NS children at presentation and longitudinally with short-term observation. Multicenter longitudinal study of children (2–18 years old) from 14 centers across the Midwest Pediatric Nephrology Consortium with incident idiopathic NS. 25(OH)D levels were assessed at diagnosis and 3 months later. Sixty-one children, median age 5 (3, 11) years, completed baseline visit and 51 completed second visit labs. All 61 (100 %) had 25(OH)D
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renin angiotensin system blocker fetopathy a midwest Pediatric Nephrology consortium report
The Journal of Pediatrics, 2015Co-Authors: Shahid Nadeem, David T Selewski, Ibrahim F. Shatat, Shireen Hashmat, Marissa J Defreitas, Katherine D Westreich, Ali Mirza Onder, Myra Chiang, Donald J Weaver, Julia SteinkeAbstract:Objectives Fetuses continue to be exposed to renin angiotensin system (RAS) blockers despite their known teratogenicity and a black box warning. We hypothesized that fetopathy from in utero exposure to RAS blockers has a broader spectrum of clinical manifestations than described previously and that there are a variety of clinical scenarios leading to such exposures. Study design This was a retrospective study performed through the Midwest Pediatric Nephrology Consortium. Cases of RAS blocker fetopathy were identified, with determination of renal and extrarenal manifestations, timing of exposure, and the explanation for the fetal exposure. Results Twenty-four cases were identified. RAS blocker exposure after the first trimester was associated with more severe renal manifestations. Chronic dialysis or kidney transplantation was required in 8 of 17 (47%) patients with RAS blocker exposure after the first trimester and 0 of 7 patients with exposure restricted to the first trimester (P = .05). Extrarenal manifestations, some not previously noted in the literature, included central nervous system anomalies (cystic encephalomalacia, cortical blindness, sensorineural hearing loss, arachnoid cysts) and pulmonary complications (pneumothorax, pneumomediastinum). RAS blocker exposure usually was secondary to absent or poor prenatal care or undiagnosed pregnancy. Conclusion RAS blocker fetopathy continues to be a cause of considerable morbidity, with more severe renal manifestations associated with exposure after the first trimester. A variety of significant extrarenal manifestations occur in these patients. Clinicians should emphasize the risk of fetopathy when prescribing RAS blockers to women of childbearing age.
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gaining the patient reported outcomes measurement information system promis perspective in chronic kidney disease a midwest Pediatric Nephrology consortium study
Pediatric Nephrology, 2014Co-Authors: David T Selewski, Maria E Ferris, John D. Mahan, Susan F Massengill, Jonathan P Troost, Larysa Wickman, Kassandra L Messer, Emily Herreshoff, Corinna Bowers, Larry A GreenbaumAbstract: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.
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gaining the promis perspective from children with nephrotic syndrome a midwest Pediatric Nephrology consortium study
Health and Quality of Life Outcomes, 2013Co-Authors: Debbie S Gipson, Maria E Ferris, John D. Mahan, David T Selewski, Susan F Massengill, Larysa Wickman, Kassandra L Messer, Emily Herreshoff, Corinna Bowers, Laurence GreenbaumAbstract:Background and objectives Nephrotic syndrome (NS) represents a common disease in Pediatric Nephrology typified by a relapsing and remitting course and characterized by the presence of edema that can significantly affect the health-related quality of life in children and adolescents. The PROMIS Pediatric measures were constructed to be publically available, efficient, precise, and valid across a variety of diseases to assess patient reports of symptoms and quality of life. This study was designed to evaluate the ability of children and adolescents with NS to complete the PROMIS assessment via computer and to initiate validity assessments of the short forms and full item banks in Pediatric NS. Successful measurement of patient reported outcomes will contribute to our understanding of the impact of NS on children and adolescents.
Rudolph P. Valentini - One of the best experts on this subject based on the ideXlab platform.
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Comprar Clinician's Manual Of Pediatric Nephrology | Rudolph P. Valentini | 9789814317870 | World Scientific Publishing
2020Co-Authors: Rudolph P. Valentini, Deepa H. ChandAbstract:Tienda online donde Comprar Clinician's Manual Of Pediatric Nephrology al precio 155,44 € de Rudolph P. Valentini | Deepa H. Chand, tienda de Libros de Medicina, Libros de Nefrologia - Nefrologia Pediatrica
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dialysis in children and adolescents the Pediatric Nephrology perspective
American Journal of Kidney Diseases, 2017Co-Authors: Deepa H. Chand, Rudolph P. Valentini, Sarah J Swartz, Shamir Tuchman, Michael J SomersAbstract:The care of children with end-stage renal disease (ESRD) is highly specialized and often poorly understood by nonPediatric providers and facility/institution administrators. As such, this position paper has been created to offer provider, facility, and institutional guidance regarding the components of care necessary for children receiving dialysis. Key differences between adult and Pediatric dialysis units are highlighted. Responsibilities and expectations of the members of the interdisciplinary dialysis team are outlined as they pertain specifically to the care of Pediatric dialysis patients. Physical and staffing requirements of the dialysis facility are reviewed, again focusing on unique needs and challenges faced by the Pediatric dialysis care team. Among these, vascular access options and proper planning of ESRD care are underscored. Pediatric quality-of-life metrics differ significantly from adult quality variables, and proper tools for assessment must be used. Endorsed by the Council of the American Society of Pediatric Nephrology (ASPN), this position paper serves as a reference tool for the provision of care to Pediatric patients with ESRD.
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antihypertensive prescription in Pediatric dialysis a practitioner survey by the midwest Pediatric Nephrology consortium study
Hemodialysis International, 2009Co-Authors: Mark M Mitsnefes, William E Smoyer, Rudolph P. ValentiniAbstract:Previous studies have indirectly suggested the prescription of antihypertensive medications may contribute to blood pressure control in dialysis patients. Before exploring this largely unknown field, it is necessary to examine if there is diversity in antihypertensive prescription for dialysis patients. The questionnaire by the Midwest Pediatric Nephrology Consortium was mailed to members of American Society of Pediatric Nephrology holding faculty positions in North America and Puerto Rico. Eighty-three (23.9%) of the mailed 357 surveys were analyzable. End-organ damage (43.2% respondents), interdialytic blood pressure levels (35.1%), achievement of dry weight (29.7%), duration of action of medications (25.7%), and underlying diseases (24.3%) were considered as the most important factor(s) in determining antihypertensive medications. For both hemodialysis and peritoneal dialysis patients, dihydropyridine-calcium channel blockers and angiotensin enzyme inhibitors were the most commonly prescribed medications. On scheduled hemodialysis days, 66.7% respondents withheld morning medications. Among them, two-thirds did not withhold all medications; they preferred withholding direct vasodilators (63.2%) > dihydropyridine-calcium channel blockers (50%) > β-blockers (25%) > angiotensin enzyme inhibitors (21.9%). 60.7% respondents gave medications back postdialysis and 66.1% held medications only for morning dialysis. For nocturnal peritoneal dialysis patients, 85.9% and 91.1% respondents did not avoid certain medications in the evening and morning, respectively. For continuous ambulatory peritoneal dialysis patients, 10.8% respondents preferred giving medications in the morning while 74.3% had no preference. Antihypertensive prescription is quite diverse among Pediatric nephrologists and its clinical significance requires further studies.
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central venous lines for chronic hemodialysis survey of the midwest Pediatric Nephrology consortium
Pediatric Nephrology, 2008Co-Authors: Denis F Geary, Rudolph P. Valentini, Deepa H. ChandAbstract:Central venous lines (CVL) continue to be the most commonly used vascular access device for children on hemodialysis (HD). Despite their frequent use, little is known regarding the frequency of CVL-related intradialytic complications that could interfere with delivery of effective dialysis. To better assess this, we conducted a cross-sectional study of ten HD centers within the Midwest Pediatric Nephrology Consortium. Vascular access was provided by CVL in 61 of the 83 patients (73%) included. CVL dysfunction (defined as reduced blood flows, need for reversed lines, or frequent intradialytic alarms) occurred in 46% in the prior month. Treatment for suspected clots occurred in 16 patients. Intraluminal tissue plasminogen activator (tPA) was the preferred treatment for a suspected clot. The survey also inquired about the preferred treatment for documented clots, and intraluminal tPA was most preferred, followed by CVL stripping, CVL removal, CVL brushing, and systemic tPA. As for preventative strategies, most HD centers locked the CVL with intraluminal heparin in concentrations ranging from 1,000 to 5,000 U/ml. In conclusion, catheter usage rates and complications were highly prevalent in Pediatric HD units in this study. As treatment strategies varied greatly, future prospective studies are needed to determine the effectiveness of each individual therapy.
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blood pressure control in Pediatric hemodialysis the midwest Pediatric Nephrology consortium study
Pediatric Nephrology, 2007Co-Authors: Rene G. Vandevoorde, Rudolph P. Valentini, Deepa H. Chand, Gina Marie Barletta, Ian G. Dresner, Jerome C. Lane, Jeffrey D. Leiser, Hiren Patel, Mark M MitsnefesAbstract:Hypertension is frequent in Pediatric patients receiving dialysis, with an especially high rate reported in children on hemodialysis (HD). We performed the present study to assess blood pressure (BP) status and identify risk factors for poor BP control in children on maintenance HD. One month’s dialysis records were collected from 71 subjects receiving HD in ten dialysis units participating in the Midwest Pediatric Nephrology Consortium (MWPNC). For each HD session, data on pre- and posttreatment weights and BPs were recorded. Hypertension, defined as mean BP ≥ 95th percentile, was found in 42 (59%) subjects. Eleven subjects (15.5%) had prehypertension, defined as mean BP between the 90th and 95th percentiles, while 18 subjects (25.3%) had normal BP (<90th percentile). BP significantly decreased at the end of a dialysis session; however, only 15 of 42 hypertensive subjects (35%) normalized their BP. Hypertensive subjects were younger (p = 0.03), had higher serum phosphorus (p = 0.01), and had more elevated posttreatment weight above estimated dry weight (p = 0.02). Logistic regression showed that younger age (p = 0.02) and higher serum phosphorus (p = 0.02) independently predicted hypertensive status. In conclusion, this study emphasizes the difficulty of BP control in Pediatric HD patients. Especially poor BP control was found in younger children; those patients who do not reach their posttreatment weight goals, perhaps reflecting their hypervolemic state; and those who have higher serum phosphorus levels.