Abstract
The ultimate goal for treatment of children with end-stage renal disease is the achievement of normal growth and development. Peritoneal dialysis (PD) is the main dialytic modality for children. According to the national registry data on children undergoing PD in Japan, 50-60 new patients under 16 years of age are enrolled each year. One third of patients were under 6 years old, indicating that PD is the treatment of choice in younger children. The data on PD, including patient survival rate, technique survival rate have improved recently. However, these rates were worse in children under 6 years of age. Careful management is needed for this age group. Fluid management with better blood pressure control is important for the prevention for cardiovascular disease, which is a significant cause of mortality. Also, because chronic renal disease results in severe psychological and social stresses in children, the supportive care for both the patients and their family from the beginning of the disease is essential.
Renal transplantation, because of its advantage for QOL, has been considered the most optimal treatment in children with end stage-renal disease. However, the waiting time for renal transplantation is long and the number of cadaver donor transplantation is very low because of a severe national shortage of cadaver donors in Japan. Therefore, patients requiring long-term PD have increased gradually. One major potential solution to improve the rate of renal transplantation in Japan is to enhance renal organ donation. The responsible pediatrician should serve a central role providing the patients and their family both essential information and support about choosing renal transplantation.
