Assessment of Quality of Life among Children with End-Stage Renal Disease: A Cross-Sectional Study.

Background: Measuring health-related quality of life is considered an important outcome indicator in evaluating health-care interventions and treatments and in understanding the burden of diseases. Objectives: This study aimed at assessing quality of life among children with end-stage renal disease, either undergoing hemodialysis or had renal transplantation therapy and comparing it with healthy controls. Methods: A cross-sectional study was conducted between December 2016 and May 2017 in Abo El-Reesh Pediatric Hospital using parent/child reports of generic module for QoL assessment: PedsQLTM Inventory version 4 for both cases and controls. Disease-specific module: PedsQLTM ESRD version 3 was used for ESRD cases. 55 ESRD cases and 86 controls were enrolled in the study. Results: Statistically significant difference between ESRD cases and controls regarding all aspects of QoL was found; total QoL mean score was 58.4 ± 15.3 and 86.8 ± 10 among cases and controls, respectively. All individual QoL domains were significantly worse in ESRD cases. Transplantation group had better Spearman's correlation between child and parents' scores which showed significant positive moderate correlation. Conclusions: ESRD and its treatment modalities are affecting negatively all aspects of quality of life; incorporating QoL assessment and management is highly recommended.

The effect of hemodialysis on Q-T interval on children with chronic renal failure.

The hemodialysis patients have a wide variety of electrocardiographic (ECG) abnormalities and, in certain instances; hemodialysis itself seems to be a cause of ECG changes and different kinds of dysrhythmias. The purpose of the study was to assess the effect of hemodialysis on QT and corrected QT (QTc) interval and QTc interval dispersion in patients with end-stage renal failure 10 min before (pre-HD) and 10 min after each hemodialysis (post-HD). An observational cross-section study was conducted on 30 patients'admitted to the dialysis unit in Abou El Ressh pediatric hospital along a period of 6 months starting from October 2008. The total number of cases on regular hemodialysis throughout the year was: 60 cases. 30 cases were picked at random to be included in the present work. Clinical examination, history taking and laboratory analysis were offered to all patients, 12 lead ECG was done before and after hemodialysis. The results showed that after hemodialysis there were significant changes for the QTc and QT dispersion with 3.3% of cases had prolonged QT interval after hemodialysis and 43.3% had prolonged QTc after dialysis and 50% had abnormal QTd after dialysis. After dialysis there was significant negative correlation between Na level and QTc, also between K level and QTc.

Central venous catheters as a vascular access modality for pediatric hemodialysis.

BACKGROUND: The use of hemodialysis catheters is an essential component of dialysis practice. Children are particularly likely to require multiple courses of dialysis over their lifetime, hence the repeated need for vascular access. These catheters remain a significant source of morbidity and mortality. METHODS: All catheters inserted for hemodialysis at the Center of Pediatric Nephrology and Transplantation, Cairo University over a period of 40 months were studied. Patient data as well as data of catheter insertion, dwell, cause of removal and complications were reported. RESULTS: A total of 195 uncuffed central venous catheters were used for temporary access in 131 patients for a mean duration of 35.7 days. Of attempted insertions, 87.4% achieved successful access, of which 56% remained for the required period, 8.9% were accidentally dislodged, and 35.1% were removed due to complications--mostly infection. The overall rate of possible catheter-related bacteremia was 9.6 episodes/ 1,000 catheter days. Infection increased with longer catheter dwell. Nineteen cuffed tunneled catheters were surgically inserted and used for up to 11 months (mean 117 days). Loss of these catheters was attributed mainly to infection (ten episodes) and catheter thrombosis (six episodes). During the study, 317 femoral catheters were inserted. CONCLUSION: Uncuffed central venous catheters are both needed and useful for short-term hemodialysis. Vascular access for extended durations may be provided by cuffed tunneled catheters. Infection is the major serious concern with both uncuffed and cuffed catheters.