Nephrology focuses on diagnosing and treating kidney diseases. The kidneys filter waste, balance fluids, regulate blood pressure, and manage acute and chronic conditions.
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After deciding on dialysis, the focus shifts to the daily routine of treatment. Dialysis is a lifestyle, not just a procedure. It requires a rhythm of care that integrates into the family’s home life. There are two primary paths: peritoneal dialysis (PD) and hemodialysis (HD). In pediatrics, PD is often the preferred choice for younger children because it can be done at home, sparing the child from frequent hospital trips.
Treatment also involves a strict schedule of medications and dietary changes. It is a comprehensive package designed to keep the child’s blood chemistry stable. Follow-up is frequent and detailed, ensuring that the dialysis prescription grows with the child. This section explores the mechanics of these treatments and the supportive care that accompanies them.
Peritoneal dialysis (PD) uses the lining of the child’s own belly as a filter. It requires a small surgery to place a soft tube, called a catheter, into the abdomen. This is the most common starting point for infants and toddlers.
Most children use a machine called a cycler. At night, parents connect the child’s catheter to the cycler. While the child sleeps, the machine automatically fills the belly with cleaning fluid and drains it out several times. This procedure allows the child to be “disconnected” during the day, free to go to school and play without being tethered to a machine.
Sometimes, extra cleaning is needed during the day. This involves a “manual exchange.” A parent or school nurse connects a bag of fluid to the catheter, lets it flow in, and then caps it off. The fluid stays in the belly for a few hours before being drained. This flexibility allows families to travel and maintain a somewhat normal schedule.
Hemodialysis (HD) cleans the blood directly. It is usually done in a specialized pediatric dialysis center.
The child travels to the clinic three or four times a week. Each session lasts three to four hours. During treatment, two needles are placed into a vascular access point (usually in the arm) to draw blood out to the machine and return it. While more disruptive to a school schedule, some families prefer this procedure because the medical professionals handle all the care, giving parents a break from being the primary “nurse” at home. It also allows children to meet peers who are going through the same thing.
For dialysis to work, there must be a way to get fluid in and out of the body. This “access” is the child’s lifeline.
For PD, it is the abdominal catheter. For HD, it is often a fistula or a graft. A surgeon connects an artery to a vein in the arm to create a strong vessel that can handle the needles. If the veins are too small, or for emergency starts, a central venous catheter (a tube in the neck or chest) is used. Caring for this access—keeping it clean and dry—is the single most important daily task to prevent infection.
Dialysis removes toxins, but it also removes some beneficial things, like vitamins. It also cannot replace the hormones the kidney makes.
Children take a cocktail of medications. This includes active vitamin D and phosphate binders to keep bones strong. They take erythropoietin injections to boost red blood cells and fight anemia. Because poor growth is a major concern, many children also receive daily injections of recombinant growth hormone. This helps them reach a normal height, which is crucial not just for appearance but for physical functioning and self-esteem.
Diet is a significant part of the treatment plan. It is stricter than a normal healthy diet.
Children must limit foods high in phosphorus (like dairy and nuts) and potassium (like bananas and potatoes). Sodium is restricted to control blood pressure and thirst. However, unlike adults who might need to limit protein, children on PD often need extra protein because they lose some in the dialysis fluid. A renal dietitian creates customized menus that balance these restrictions with the child’s picky eating habits and need for calories.
Dialysis is rarely the final destination for a child. It is a bridge to a kidney transplant.
The medical team constantly evaluates the child’s readiness for transplant. This involves monitoring their heart health, ensuring they are infection-free, and waiting for them to reach a certain size (often around 10 kg) to safely receive an adult-sized kidney. Follow-up appointments are monthly or even biweekly. These visits track the effectiveness of the dialysis (Kt/V score), nutritional status, and school progress, always with the goal of moving towards a successful transplant.
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Yes. Nurses thoroughly train parents for weeks before they begin home dialysis. You will learn how to handle the machine and solve problems safely.
Not necessarily. The dietitian can help you plan for special treats. It could mean taking an extra “binder” pill with the cake to absorb the phosphorus.
The machines have battery backups for short outages. For long outages, you are trained to perform manual exchanges using gravity, so treatment continues without electricity.
Numbing creams are applied to the skin beforehand. Distraction with tablets or games, and the support of child life specialists, helps reduce anxiety over time.
Swimming is tricky. Children with HD catheters usually cannot swim. Children with PD catheters may swim in the ocean or chlorinated pools if the site is properly covered and cleaned immediately after.
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