Clinical Performance Measures & Outcomes in Adolescents

Summary

Principal Investigator: S L Furth
Abstract: In 1999, there were over 7,000 children and adolescents in the U.S. with end stage renal disease (ESRD). Among this group, Medicare payments for pediatric hemodialysis patients exceeded $48,000 per patient year at risk. Fortunately, long-term survival among pediatric dialysis patients (aged 0-19 yrs) is excellent, with 10-year survival probabilities of almost 70% (adjusted for age, gender, race and primary diagnosis) according to the USRDS. However, children and youth who develop ESRD will require some form of renal replacement therapy their entire lives. Recent studies show that despite excellent long-term survival, children with ESRD still require frequent hospitalizations, have abnormal growth, and high rates of complications. Research to define standards for care in pediatric hemodialysis and whether achievement of these standards can improve long-term outcomes and decrease the cost of care for this population is essential. Although these adult standards are frequently applied in assessing the clinical care of children and adolescents maintained on dialysis, little evidence exists to justify the direct application of these standards to children. To our knowledge, no longitudinal study has assessed the health outcomes for children and adolescents on dialysis according to whether or not CPM target hemoglobin, adequacy or serum albumin levels were reached. To address this gap in current knowledge, we propose a longitudinal analysis of prevalent pediatric ESRD in-center hemodialysis patients identified in the 2000 and 2001 CPM project. Linkage of the 2000 (n=433) and 2001 (n=257) CPM data, in which 690 pediatric in-center hemodialysis patients were studied, with outpatient, hospitalization, transplant and survival data from the US Renal Data System will allow an initial assessment of the clinical relevance of adult CPM standards in adolescents and teens with ESRD.
Funding Period: 2004-09-01 - 2007-08-31
more information: NIH RePORT

Top Publications

  1. ncbi Hospitalization rates and clinical performance measures in U.S. adolescent hemodialysis patients
    Gregory Gorman
    Section on Pediatric Nephrology, Walter Reed Army Medical Center, National Naval Medical Center, Washington DC, USA
    Pediatr Nephrol 25:2335-41. 2010
  2. ncbi Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients
    Gregory Gorman
    Department of Pediatrics and Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
    Am J Kidney Dis 47:285-93. 2006
  3. ncbi Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis
    Sandra Amaral
    Emory University School of Medicine, Division of Pediatric Nephrology, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA
    J Am Soc Nephrol 17:2878-85. 2006
  4. ncbi Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the Clinical Performance Measures and US Renal Data System projects
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    Clin J Am Soc Nephrol 1:987-92. 2006
  5. ncbi Children on long-term dialysis in the United States: findings from the 2005 ESRD clinical performance measures project
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
    Am J Kidney Dis 50:958-66. 2007
  6. pmc Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis
    Sandra Amaral
    Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA
    Clin J Am Soc Nephrol 3:759-67. 2008
  7. pmc Patterns of use of vascular catheters for hemodialysis in children in the United States
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Baltimore, MD 21287, USA
    Am J Kidney Dis 53:91-8. 2009

Scientific Experts

Detail Information

Publications7

  1. ncbi Hospitalization rates and clinical performance measures in U.S. adolescent hemodialysis patients
    Gregory Gorman
    Section on Pediatric Nephrology, Walter Reed Army Medical Center, National Naval Medical Center, Washington DC, USA
    Pediatr Nephrol 25:2335-41. 2010
    ..Tracking adult-defined HD measures is appropriate for assessing hospitalization risk in adolescent patients, although no evidence for a cause-and-effect relationship exists...
  2. ncbi Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients
    Gregory Gorman
    Department of Pediatrics and Epidemiology, Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD, USA
    Am J Kidney Dis 47:285-93. 2006
    ..2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents...
  3. ncbi Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis
    Sandra Amaral
    Emory University School of Medicine, Division of Pediatric Nephrology, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA
    J Am Soc Nephrol 17:2878-85. 2006
    ..Further studies in the form of randomized, clinical trials are needed to assess optimal Hb levels for adolescents who are on HD...
  4. ncbi Clinical course associated with vascular access type in a national cohort of adolescents who receive hemodialysis: findings from the Clinical Performance Measures and US Renal Data System projects
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
    Clin J Am Soc Nephrol 1:987-92. 2006
    ..69) for a complication of vascular access. Vascular catheters are the predominant access type in adolescent patients who receive maintenance hemodialysis and are associated with significantly more hospitalizations and complications...
  5. ncbi Children on long-term dialysis in the United States: findings from the 2005 ESRD clinical performance measures project
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
    Am J Kidney Dis 50:958-66. 2007
    ..This study describes demographic and clinical characteristics and compares them between patients on HD and PD therapy...
  6. pmc Serum albumin level and risk for mortality and hospitalization in adolescents on hemodialysis
    Sandra Amaral
    Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA
    Clin J Am Soc Nephrol 3:759-67. 2008
    ..This study examined the association between albumin and risk for death and hospitalization in adolescents who are on hemodialysis...
  7. pmc Patterns of use of vascular catheters for hemodialysis in children in the United States
    Jeffrey J Fadrowski
    Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe Street, Baltimore, MD 21287, USA
    Am J Kidney Dis 53:91-8. 2009
    ..Identifying the reasons for the high prevalence of vascular catheters in children on HD therapy is necessary to assess whether targeted interventions may increase the prevalence of AVFs/AVGs...