Objectives of IPDN - Annual Dialysis Clinicannualdialysisconference.org/.../Warady_IPDN.pdf · Network (IPDN) Objectives of IPDN Improve the quality of pediatric dialysis care worldwide

Miami NEONATE WITH ESRD, March, 2017

© The Children's Mercy Hospital, 2016

Bradley A. Warady, M.D.Professor of Pediatrics

University of Missouri - Kansas CityDirector, Division of Nephrology

Director, Dialysis and TransplantationChildren’s Mercy Kansas City

International Pediatric Dialysis Network (IPDN)

Objectives of IPDN■ Improve the quality of pediatric dialysis care worldwide

■ Collect basic information regarding pediatric dialysis practices and outcomes

■ Provide useful tools and management algorithms for daily dialysis practice

■ Provide global benchmarking of pediatric dialysis outcomes

■ Perform prospective observational studies on important clinical issues in pediatric dialysis


©2015 Children's Mercy Hospitals and Clinics. All Rights Reserved.

International Pediatric Dialysis Network

IPPN3403 Patients

122 Centers43 Countries

IPHN799 Patients

81 Centers36 Countries


Characterization of 452 Access Revisions by Indication and Time on Peritoneal Dialysis

Borzych-Duzalka et al. CJASN , 2016


©2015 Children's Mercy Hospitals and Clinics. All Rights Reserved. Borzych-Duzalka et al. CJASN, 2016

Access Survival in 824 Incident Patients According to Patient Age at Catheter Insertion


Technique Survival

Borzych-Duzalka et al. CJASN, 2016




Baseline Patient and Treatment Characteristics

Total population

BMI <2.5th

percentile8.9%

BMI 2.5th-85th pct

71.4%

BMI > 85th pct

19.7%P

N=1001 n=89 n=715 n=197Country GNI per capita (1000$) 27.1 � 13.6 24.0 � 13.2 27.0 � 13.4 28.6 � 14.5 0.030Age (yrs) 8.5 � 5.8 7.7 � 5.9 8.7 � 5.8 8.1 � 5.8 0.176Male gender 550 (55%) 50 ( 56.2%) 388 (54.3%) 112 ( 56.9%) 0.788Renal diagnosisCAKUTGlomerulopathyOther

424 (42.4%)388 (38.8%)189 (18.9%)

44 (49.4%)30 (33.7%)15 (16.9%)

291 (40.7%)292 (40.8%)132 (18.5%)

89 (45.2%)66 (33.5%)42 ( 21.3%)

0.235

Comorbidities 355 (35.5%) 38 (42.7%) 250 (35.0%) 67 (34.0%) 0.318eGFR at PD start (ml/min/1.73m2) 8.0 (5.3) 7.3 (5.1) 7.9 (5.2) 8.8 (5.6) 0.007Urine output (L/m2/d) 0.61 (0.94) 0.53 (0.85) 0.63 (0.93) 0.56 (1.05) 0.803PD modalityCAPDAPD Other

222 ( 22.6%)759 ( 77.4%)13 (1.3 %)

23 (25.8%)60 (67.4%)6 (6.7 %)

156 (21.8%)547 (76.5%)

6 (0.8%)

43 (21.8%)152 (77.2%)

1 (0.5%)

0.512

Biocompatible PD fluid use 428 (42.8 %) 33 (37%) 316 (44.2%) 79 (40.1%) 0.313Height SDS -1.9 � 1.7 -1.6 � 2.1 -1.8 � 1.6 -2.3 � 1.8 <0.001Nutritional supplementationNone Oral supplementsNG tubePEG

595 (59.4%)218 (21.8%)

92 (9.2%)96 (9.6%)

54 (60.7%)24 (27%)6 (6.7%)5 (5.6%)

428 (59.9%)160 (22.4%)69 (9.6%)58 (8.1%)

113 (57.4%)34 (17.3%)17 (8.6%)33 (16.7%)

0.007

Amino acid PD fluid use 12 (1.2 %) 4 (4.5%) 5 (0.6%) 3 (1.5%) 0.007Growth hormone use 64 (6.4%) 3 (3.4 %) 50 (7.0%) 11 (5.6%) 0.367Hemoglobin (g/L) 10.8 � 1.9 11.0 � 2.1 10.8 � 1.9 10.8 � 1.8 0.612Serum albumin (g/l) 35.8 � 6.9 36.2 � 5.4 35.6 � 7.2 36.2 � 6.6 0.519Blood urea (mg/dl) 96 (63) 93 (64) 97 (63) 93 (62) 0.524Serum bicarbonate (mM) 23.9 � 4.3 23.7 � 4.1 23.9 � 4.2 24.2 � 4.7 0.631Serum phosphorus (mM) 1.8 � 0.6 1.8 � 0.6 1.8 � 0.6 1.7 � 0.6 0.204

Baseline Patient and Treatment Characteristics

Total population

BMI <2.5th

percentile8.9%

BMI 2.5th-85th pct

71.4%

BMI > 85th pct

19.7%P


424 (42.4%)388 (38.8%)189 (18.9%)

44 (49.4%)30 (33.7%)15 (16.9%)

291 (40.7%)292 (40.8%)132 (18.5%)

89 (45.2%)66 (33.5%)42 ( 21.3%)

0.235


222 ( 22.6%)759 ( 77.4%)13 (1.3 %)

23 (25.8%)60 (67.4%)6 (6.7 %)

156 (21.8%)547 (76.5%)

6 (0.8%)

43 (21.8%)152 (77.2%)

1 (0.5%)

0.512


595 (59.4%)218 (21.8%)

92 (9.2%)96 (9.6%)

54 (60.7%)24 (27%)6 (6.7%)5 (5.6%)

428 (59.9%)160 (22.4%)69 (9.6%)58 (8.1%)

113 (57.4%)34 (17.3%)17 (8.6%)33 (16.7%)

0.007



Regional Variation of Nutritional Status at Start of CPD

0%

20%

40%

60%

80%

100%

Korea (24) Canada(13)

LatinAmerica

(202)

WesternEurope(300)

China /Hong Kong

(77)

NewZealand

(18)

Turkey(105)

CentralEurope(120)

USA (97) India/SEAsia (30)

MiddleEast (15)

Malnutrition Normal Weight Overweight Obesity

15.7% 16.7%

33%40%

20%

Regional Differences in Supplementary Feeding Practices in 386 Children < 6 Years

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ANZAC (8

)

USA (3

5)

West EU (1

46)

Latin Americ

a (66)

Canada (

3)

Korea (4)

ME (8)

India/SE Asia

(8)

Central EU

(47)

Turkey (

42)

China/HKG (1

9)

None

Oral Suppl

NGT

PEG

Multivariate Analysis of Factors Predicting BMI SDS at Start of CPD

Estimate (SE) P

Intercept -0.284 (0.130) 0.029

eGFR 0.020 (0.009) 0.036

Comorbidities -0.156 (0.101) 0.121

Nutritional supplementation (reference = none)

OralNGTPEG

-0.180 0.1560.446

(0.117)(0.169)(0.169)

0.1230.3570.009



Estimate (SE) P

Intercept -0.284 (0.130) 0.029

eGFR 0.020 (0.009) 0.036

Comorbidities -0.156 (0.101) 0.121


OralNGTPEG

-0.180 0.1560.446

(0.117)(0.169)(0.169)

0.1230.3570.009

Course of BMI SDS According to Nutritional Status at Start of PD

Overwt/obesityNormalMalnutrition

Factors Predicting Prospective Annualized Change in BMI SDS

Parameter Estimate (SE) P

Intercept -0.056 (0.259) 0.828Duration of PD (years) -0.060 (0.036) 0.094Diagnosis (reference: CAKUT)

GlomerulopathyOther

-0.229 -0.364

(0.089)(0.110)

0.0100.001

BMI SDS -0.456 (0.026) <0.001Height SDS 0.113 (0.025) <0.001% deviation from estimated dry weight -0.040 (0.014) 0.008Serum albumin (g/L) 0.015 (0.006) 0.015Nutritional supplementation (reference: none)

OralNGTPEG

-0.195 0.122 0.633

(0.090)(0.133)(0.132)

0.0310.358

<0.001





GlomerulopathyOther

-0.229 -0.364

(0.089)(0.110)

0.0100.001


OralNGTPEG

-0.195 0.122 0.633

(0.090)(0.133)(0.132)

0.0310.358

<0.001

Survival of Patients with and without Malnutrition at Last Observation

p = 0.028

Hazard Ratios of Death According to Age and BMI SDS



Vascular Access in Prevalent Pediatric HD Patients

USRDS, 2017


CVL (n = 404) AVF (n = 143) AVG (n = 5) p

Males (n/%) 224 (55) 84 (59) 2 (40) 0.5

Initial Modality (n/% HDF) 45 (11) 42 (29) 1 (20) <0.001

Age (median /IQR) 11.1 (6.5; 14.7) 13.7 (11.4; 15.8) 13.6 (12.4; 16.3) <0.001

Diagnosis:CAKUT (n, %)GLM (n, T)

171 (42)101 (24)

63 (44)35 (25)

3 (60)--

0.60.7

Comorbidities (n, %):Syndromal/genetic diseaseCardiopulmonarySensory loss (vision, hearing)

105 (26)61 (15)55 (14)

28 (20)12 (8)13 (9)

1 (20)1 (20)3 (60)

0.050.020.01

Height SDS (median/IQR) -1.8 (-3.3; -0.8) -1.4 (-2.2; -0.6) 0.2 (0.0; 0.7) 0.01

BMI SDS (median/IQR) -0.1 (-1; 0.8) -0.2 (0-0.7; 0.5) 0.2 (0; 0.8) 0.4

Region n (% of access per region): 0.01

Western EuropeCentral/Eastern EuropeTurkeyAsiaMiddle EastNorth AmericaLatin AmericaANZAC

191 (68)41 (65)

50 (73.5)72 (90)16 (84)25 (93)7 (70)2 (67)

89 (31)21 (33)

16 (23.5)8 (10)3 (16)2 (7)

3 (30)1 (33)

2 (1)1 (2)2 (3)

00000

Renal transplantationCadaveric n (%)Living related n (%)

156 (39)101 (65)55 (35)

56 (36)46 (82)10 (18)

0 0.50.010.01

Demographics of Patients with CVL andAVF/AVG at First Access Placement

CVL (n = 404) AVF (n = 143) AVG (n = 5) p

Males (n/%) 224 (55) 84 (59) 2 (40) 0.5


Age (median /IQR) 11.1 (6.5; 14.7) 13.7 (11.4; 15.8) 13.6 (12.4; 16.3) <0.001


171 (42)101 (24)

63 (44)35 (25)

3 (60)--

0.60.7


105 (26)61 (15)55 (14)

28 (20)12 (8)13 (9)

1 (20)1 (20)3 (60)

0.050.020.01





191 (68)41 (65)

50 (73.5)72 (90)16 (84)25 (93)7 (70)2 (67)

89 (31)21 (33)

16 (23.5)8 (10)3 (16)2 (7)

3 (30)1 (33)

2 (1)1 (2)2 (3)

00000


156 (39)101 (65)55 (35)

56 (36)46 (82)10 (18)

0 0.50.010.01



Choice of Vascular Accessby Age

-30

20

70

120

170

220

<2 2 to 6 6 to 10 10 to 15 >15

Num

ber o

f pat

ient

s

CVL

AVFAVG

CVL (72%)

AVF (26%)

AVG (2%)

Clinical, Dialytic and Biochemical Parameters and ESA Dosing at Study Entry and 6 Monthly Updates

by Vascular Access Type CVC AVF AVG p

Age at access placement (median /IQR)

11.0 (6.3;14.7) 13.7 (10.9; 15.8) 16.5 (12.1; 18) <0.001

Access observation time (mo) 15 (6;25)bc 22 (11;40)a 24 (9;28)a <0.001Blood flow rate (ml/min/m2) 167±54b 176±53a 180±57 0.02Dialysate flow rate (ml/min/m²) 508±229bc 374±112a 423±161a <0.001Kt/V urea 1.66±0.59bc 1.74±0.54ac 1.99±0.68ab <0.001

Hemoglobin (g/l) 10.4 ± 1.76b 11.09 ± 1.7c 10.1 ± 1.6b <0.001Serum ferritin (ng/ml) 401 ± 386bc 459 ± 485a 568 ± 396a 0.003Transferrin Saturation (%) 30.2 ± 17.2 30.7 ± 16.6 27.1 ± 13.8 0.3Serum albumin (g/l) 39.4 ± 5.5b 40.6 ± 4.9a 39.2 ± 4.44 <0.001CRP (mg/l) 16 ± 50b 10 ± 36a 13 ± 20 0.06ESA dose (IU/kg/wk) 266 ± 190bc 195 ± 148a 191 ± 142a <0.001ESA dose (IU/m2/wk) 7055 ± 4693bc 5911 ± 4052a 5483 ± 3939a <0.001ERI (IU/m2/wk per g/dl Hb) 704 ± 499b 564 ± 482a 569 ± 439 <0.001

a p<0.05 versus CVC; b p<0.05 versus AVF ; C p<0.05 versus AVG; ESA=erythropoiesis stimulating agent, ERI = ESA resistance index


by Vascular Access Type

CVC AVF AVG p

Age at access placement (median /IQR)

11.0 (6.3;14.7) 13.7 (10.9; 15.8) 16.5 (12.1; 18) <0.001

Access observation time (mo) 15 (6;25)bc 22 (11;40)a 24 (9;28)a <0.001Blood flow rate (ml/min/m2) 167±54b 176±53a 180±57 0.02Dialysate flow rate (ml/min/m²) 508±229bc 374±112a 423±161a <0.001Kt/V urea 1.66±0.59bc 1.74±0.54ac 1.99±0.68ab <0.001

Hemoglobin (g/l) 10.4 ± 1.76b 11.09 ± 1.7c 10.1 ± 1.6b <0.001Serum ferritin (ng/ml) 401 ± 386bc 459 ± 485a 568 ± 396a 0.003Transferrin Saturation (%) 30.2 ± 17.2 30.7 ± 16.6 27.1 ± 13.8 0.3Serum albumin (g/l) 39.4 ± 5.5b 40.6 ± 4.9a 39.2 ± 4.44 <0.001CRP (mg/l) 16 ± 50b 10 ± 36a 13 ± 20 0.06ESA dose (IU/kg/wk) 266 ± 190bc 195 ± 148a 191 ± 142a <0.001ESA dose (IU/m2/wk) 7055 ± 4693bc 5911 ± 4052a 5483 ± 3939a <0.001ERI (IU/m2/wk per g/dl Hb) 704 ± 499b 564 ± 482a 569 ± 439 <0.001a p<0.05 versus CVC; b p<0.05 versus AVF ; C p<0.05 versus AVG; ESA=erythropoiesis stimulating agent, ERI = ESA resistance index


Multivariate Logistic Regression Analysis of Risk Factors for CVC Dysfunction

OR (95% CI) P

Age 0.98 (0.94 – 1.02) 0.26

Access site – internal jugular 0.30 (0.13 – 0.68) <0.001

Access site – subvlavian 0.66 (0.26 – 1.66) 0.79

Access site – femoral 1.2 (0.40 – 3.59) 0.08


Primary Access Patency Rates

p = <0.0001


Remote Patient Monitoring

1.43.9

0.02

0.4

3.6

1.25

0.4

2.2

0.1

0.1

0.17

0.7

4.115.9

8.1

4.0

11.8

11.4

Shortage of nephrologists and hospitals offering dialysis and transplantation for adults in the developing world

(www.globaldialysis.com, 2007) Dialysis unit per million population

http://www.globaldialysis.com/



PD Cyclers


Sharesource Clinical Portal-Two Way Communication

Baxter

• Remote firmware upgrades

• Technical service support

Sharesource Platform

Patient at Home

• Conversations with clinician more fruitful, as all patient treatment data is accessible through portal.

Clinician at Clinic

• Access to review each patient’s dialysis therapy each morning

• Dashboard with flagged alarms. highlighting patient events.

• Potential earlier detection of clinical issues.

• Access to patient’s historical treatment files.

• Remote change of device dialysis settings from the hospital direct to patient’s device at home.


*Initial RPM questionnaire■ Frequency of RPM data assessment ■ Alert systems chosen ■ Procedure for health care provider RPM feedback to patients

*Annual RPM questionnaires■ Specific changes in center RPM settings ■ Work load for doctors / nurses (semi-quantitatively) ■ Acceptance by patients, parents, doctors and nurses (semi-quantitatively)■ Estimates on changes in PD regime / medication performed based on RPM

data and estimates on how often the modification proved to be beneficial

6 month updates:■ Type of RPM* ■ Number of outpatient visits ■ Body weight/length, biochemistry, medication, PD modalities, blood pressure,

echocardiography, 24 h ABPM ….■ Access revisions, peritonitis, exit-site infections, hospitalizations …■ Transient / permanent discontinuation of RPM (reasons)

Remote Patient Monitoring

■ Frequency of outpatient and emergency room visits

■ Frequency, reasons and duration of hospitalizations

■ PD prescription, UF capacity, % deviation from estimated dry weight

■ Bioimpedance data, blood pressure control (office and 24 h ABPMs), echocardiography findings

■ Biochemical profile

■ Medication usage

■ Infectious complications and outcome, catheter revisions, technique failure, modality switch and death

Answers from the IPPN: RPM versus non-RPM PD

■ The IPDN is a source of global information on the performance of

dialysis in children cared for in pediatric dialysis programs

■ The linking of treatment data to longitudinal patient outcome data

makes the IPDN a valuable resource to help guide clinical

management and improve patient care

■ The success of the IPDN is dependent on the voluntary

participation of dialysis programs and patients worldwide

■ Individuals/sites interested in participating in the IPDN should

contact Brad Warady ([email protected]) or Franz Schaefer

([email protected])

Summary

mailto:[email protected]

mailto:[email protected]



International Pediatric Dialysis Network

www.pedpd.org

End

History of Peritoneal DialysisInvestigator Description DateGanter First human peritoneal dialysis 1923

Wear, Sisk & Trinkle First successful treatment of ARF with PD 1938

Frank, Seligman & Fine Seminal studies of PD in ARF in animals and humans

1946-1948

Grollman Long-dwell PD for uremia in animals & humans 1951

Maxwell IPD for ARF, commercially available dialysis solutions, and nylon catheter

1959

Doolan IPD for ARF, PVC catheter 1959

Palmer, Tenckhoff Silicone catheters 1963-67

Popovich, Moncrief Described CAPD 1976

Diaz-Buxo Described CCPD 1981



Weight Status Stratified by Modality and Age

Bonthuis, M. et al., Nephrol Dial Transplant, 2013


PD Cyclers


0

20

40

60

80

100

120

Before PD start (n=25) <1 mo (n=100) 1mo to 1y (n=162) >1y (n=165)

Num

ber o

f cat

hter

s

Leak

Dysfunction

Peritonitis

ESI/Tunnel Inf

Other

Characterization of 452 Access Revisions by Indication and Time on PD

Borzych-Duzalka D., et al., (Submitted)



Residual Diuresis by Diuretic Therapy

Ha I-S, et al., Kidney Int, 2015


PD Cycler Card System Non- Adherence of Pediatric Patients to

Automated PD

51 children, 45% exhibited some non-adherence to prescribed PD regimen

Chua A and Warady B. Ped Neph (2011)

Sharesource Key Features

Patient Daily TreatmentSummary:

■ Full cycle visibility

■ Drain pattern

■ Weight, blood pressure and UF trends

■ Record of all continuous alarms

Example of Drain Problems Secondary to Constipation


Multivariate Logistic Regression Analysis of Risk Factors for AVF Dysfunction

Age OR (95% CI) P

Access site – upper arm (ref. forearm) 0.98 (0.87 – 1.11) 0.002

Access site – cubital (ref. forearm) 1.09 (0.35 – 3.38) 0.45

Access site – brachiocephalic (ref. forearm) 0.23 (0.03 – 1.84) 0.13

Puncture technique – button hole (ref. rope ladder) 0.66 (0.25 – 1.76) 0.41

Weight Status Stratified by Modality and Age

Bonthuis, M. et al., Nephrol Dial Transplant, 2013

Supplemental Feeding and Growth

Rees L et al. JASN 2011;22:2303-2312

•Mean BMI improved in NGT/Gtube while it decreased in Demand (p<0.05)•Mean Length decreased the least in Gtube vs Demand (p<0.05)



0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

NorthAm

Europe LatinAm

Asia Turkey

CCPD

NIPD

CAPD

PD Modalities


IPDN Website


IDPN Aims■ Improve the quality of pediatric dialysis care worldwide

■ Collect basic information regarding pediatric dialysis practices and outcomes

■ Provide useful tools and management algorithms for daily dialysis practice

■ Provide global benchmarking of pediatric dialysis outcomes

■ Perform prospective observational studies on important clinical issues in pediatric dialysis


Variation of Nutritional Status at Start of CPD by Age

Title?

Thumfart J. Ped Neph 2017




GlomerulopathyOther

-0.229 -0.364

(0.089)(0.110)

0.0100.001


OralNGTPEG

-0.195 0.122 0.633

(0.090)(0.133)(0.132)

0.0310.358

<0.001



Estimate (SE) P

Intercept -0.284 (0.130) 0.029

eGFR 0.020 (0.009) 0.036

Comorbidities -0.156 (0.101) 0.121


OralNGTPEG

-0.180 0.1560.446

(0.117)(0.169)(0.169)

0.1230.3570.009

CVL (n = 404) AVF (n = 143) AVG (n = 5) p

Males (n/%) 224 (55) 84 (59) 2 (40) 0.5


Age (median /IQR) 11.1 (6.5; 14.7) 13.7 (11.4; 15.8) 13.6 (12.4; 16.3) <0.001


171 (42)101 (24)

63 (44)35 (25)

3 (60)--

0.60.7


105 (26)61 (15)55 (14)

28 (20)12 (8)13 (9)

1 (20)1 (20)3 (60)

0.050.020.01





191 (68)41 (65)

50 (73.5)72 (90)16 (84)25 (93)7 (70)2 (67)

89 (31)21 (33)

16 (23.5)8 (10)3 (16)2 (7)

3 (30)1 (33)

2 (1)1 (2)2 (3)

00000


156 (39)101 (65)55 (35)

56 (36)46 (82)10 (18)

0 0.50.010.01




No of observations 907 559 48Age at access placement (median /IQR)

11.0 (6.3;14.7) 13.7 (10.9; 15.8) 16.5 (12.1; 18) <0.001

Access observation time (mo) 15 (6;25)bc 22 (11;40)a 24 (9;28)a <0.001

Blood flow rate (ml/min/m2) 167±54b 176±53a 180±57 0.02Dialysate flow rate (ml/min/m²) 508±229bc 374±112a 423±161a <0.001Kt/V urea 1.66±0.59bc 1.74±0.54ac 1.99±0.68ab <0.001







11.0 (6.3;14.7) 13.7 (10.9; 15.8) 16.5 (12.1; 18) <0.001





Patient and Treatment Baseline Characteristics

Total population

BMI <2.5th

percentile8.9%

BMI 2.5th-85th pct

71.4%

BMI > 85th pct

19.7%P


424 (42.4%)388 (38.8%)189 (18.9%)

44 (49.4%)30 (33.7%)15 (16.9%)

291 (40.7%)292 (40.8%)132 (18.5%)

89 (45.2%)66 (33.5%)42 ( 21.3%)

0.235


222 ( 22.6%)759 ( 77.4%)13 (1.3 %)

23 (25.8%)60 (67.4%)6 (6.7 %)

156 (21.8%)547 (76.5%)

6 (0.8%)

43 (21.8%)152 (77.2%)

1 (0.5%)

0.512


595 (59.4%)218 (21.8%)

92 (9.2%)96 (9.6%)

54 (60.7%)24 (27%)6 (6.7%)5 (5.6%)

428 (59.9%)160 (22.4%)69 (9.6%)58 (8.1%)

113 (57.4%)34 (17.3%)17 (8.6%)33 (16.7%)

0.007






11.0 (6.3;14.7) 13.7 (10.9; 15.8) 16.5 (12.1; 18) <0.001





Generalized Linear Model Analysis of Factors Predicting Hemoglobin Level

Estimate (SE) PIntercept 10.059 (0.383) <0.001Age - 0.019 (0.011) 0.079Dialysis vintage 0.001 (0.002) 0.863Vascular access type (reference = none)

CVC

AVF

Underlying renal disease - CAKUT

Presence of comorbidities

ESA dose (IU/kg/week)

Dialysis hrs per week

0.452

0.162

0.267

0.033

-0.001

0.033

(0.283)

(0.284)

(0.095)

(0.096)

(0.001)

(0.014)

0.111

<0.001

0.005

0.729

<0.001

0.024

CAKUT – congenital anomalies of kidney or urinary tract

Generalized Linear Model Analysis of Factors Predicting Hemoglobin Level

Estimate (SE) PIntercept 10.059 (0.383) <0.001Age - 0.019 (0.011) 0.079Dialysis vintage 0.001 (0.002) 0.863Vascular access type (reference = none)

CVC

AVF

Underlying renal disease - CAKUT

Presence of comorbidities

ESA dose (IU/kg/week)

Dialysis hrs per week

0.452

0.162

0.267

0.033

-0.001

0.033

(0.283)

(0.284)

(0.095)

(0.096)

(0.001)

(0.014)

0.111

<0.001

0.005

0.729

<0.001

0.024

CAKUT – congenital anomalies of kidney or urinary tract

Objectives of IPDN - Annual Dialysis Clinicannualdialysisconference.org/.../Warady_IPDN.pdf · Network (IPDN) Objectives of IPDN Improve the quality of pediatric dialysis care worldwide

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