Optimizing cardiovascular outcomes in pediatric dialysis.

Abstract

Dialysis is a life-sustaining treatment but comes with a very high burden of cardiovascular (CV) morbidity and mortality risk. CV events account for almost 30% of deaths in children receiving dialysis. Multiple risk factors for CV disease, both traditional and uremia-related, are present in children before they even start kidney replacement therapy and increase in prevalence and severity on dialysis. Peritoneal dialysis, as well as the conventional 3 times per week regimen of hemodialysis, offers only suboptimal clearance of uremic toxins and fluid removal. Intensified dialysis regimens, in the form of adding in convective clearance with hemodiafiltration or increasing dialysis time with longer or more frequent sessions in home hemodialysis, may offer some cardioprotective effect, but data in children are scarce. Importantly, several risk factors for CV damage are modifiable and their early diagnosis and management are crucial to mitigate CV damage. Intensified dialysis may attenuate the progression of subclinical CV disease, but no treatment to date has shown that the inexorable progression of CV disease can be reversed. Children on dialysis have a lifetime of kidney replacement therapy ahead of them, so our management must focus on early diagnosis and robust preventive strategies to give them the best chance of optimal CV health and survival. In this mini review, we discuss the key risk factors for CV disease and how to optimize CV outcomes in children receiving dialysis.