Sleep disorders in children and adolescents on regular hemodialysis.

Sleep disorders in children with chronic kidney disease have been assessed in a limited number of studies. Our aim was to characterize the types of sleep disorders in children on regular hemodialysis and to detect the predictors of sleep efficiency in those children. Forty children and adolescents on regular hemodialysis and another 40 age- and gender-matched control groups were interviewed to answer a questionnaire-based survey, a modified Epworth Sleepiness Scale, to assess excess daytime sleepiness. Also, they underwent an overnight in-laboratory polysomnography to assess total sleep time, sleep efficiency, sleep staging, apnea/hypopnea index, and periodic limb movement index. We found poor sleep efficiency in 20% of cases, and periodic limb movement index higher than 5 in 45%, and apnea/hypopnea index higher than 5 in 40%. There was significant negative correlation between sleep efficiency on one hand, and serum potassium, serum creatinine, and sleep onset on other hand (p < 0.001, p < 0.001, and p < 0.001, respectively). There was significant decrease in hemoglobin, serum iron, and transferrin saturation in patients with excess daytime sleepiness (p < 0.001, p = 0.003, and p = 0.010, respectively). By using multivariate linear regression analysis, we found that serum creatinine was the single independent predictor of sleep efficiency.Conclusion: Poor sleep quality is not uncommon in hemodialysis children. Our results show a lower frequency of sleep disorders in comparison with previous studies. There is a strong association between kidney dysfunction and poor sleep quality in HD children.What is known:• Sleep disturbances can adversely affect a child's daytime performance.• Sleep disorders in children with chronic kidney disease have been assessed in only a limited number of studies.What is new:• Poor sleep quality is not uncommon in hemodialysis children.• There is a strong association between kidney dysfunction and poor sleep quality in hemodialysis children.

Serum Soluble Interleukin 2 Receptor Level as a Marker of Acute Rejection in Pediatric Kidney Transplant Recipients.

BACKGROUND: Despite advances in immunosuppression, acute allograft rejection remains one of the key factors affecting patient and graft survival in pediatric kidney transplantation. The aim of the study is to evaluate the role of serum soluble IL2 receptor (sIL2R) level as a noninvasive assessment parameter of acute rejection (AR). METHOD: Serum sIL2R level was measured (using enzyme-linked immune-sorbent assay technique) in 60 pediatric kidney transplant recipients (30 recipients with AR and 30 transplant recipients with stable graft function). RESULTS: The mean values of sIL2R level in patients experiencing AR (14.8 ± 6.54) ng/mL were significantly higher than that in patients with stable graft functions (6.44 ±1.95) ng/mL (p = 0.0001). In addition; patients with AR proved by graft biopsy had their mean values of sIL2R level (16.19 ± 7.48) ng/mL significantly higher than that of other recipients in the study population (p = 0.032). CONCLUSION: Serum sIL2R level may serve as a noninvasive diagnostic indicator in pediatric kidney transplant recipients experiencing AR.