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Background There has been growing support for the adoption of telehealth (TH) services in pediatric populations. Children on chronic peritoneal dialysis (PD) represent a vulnerable population that could benefit from increased use of TH. The COVID-19 pandemic prompted rapid adoption of TH services in the population among pediatric centers participating in The Children's Hospital Association's Standardizing Care to Improve Outcomes in Pediatric ESKD (SCOPE) Collaborative. Methods We developed a survey to explore the experience of both pediatric PD providers and caregivers of patients receiving PD care at home and using TH services during the COVID-19 pandemic. Results We obtained responses from 27 out of 53 (50.9%) SCOPE centers that included 175 completed surveys from providers and caregivers. Major challenges identified by providers included inadequate/lack of physical exam, inability to visit with the patient/family in-person, and inadequate/lack of PD catheter exit site exam. Only 51% of caregivers desired future TH visits; however, major benefits of TH for caregivers included no travel, visit takes less time, easier to care for other children, more comfortable for patient, and no time off from work. Providers and caregivers agreed that PD TH visits are family centered (p = 0.296), with the lack of a physical exam (p < 0.001) and the inability to meet in-person (p = 0.002) deemed particularly important to caregivers and providers, respectively. Conclusions TH is a productive and viable visit option for children on PD; however, making this a successful, permanent part of routine care will require an individualized approach with standardization of core elements. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information., Author(s): Stephanie L. Clark [sup.1] , Brandy Begin [sup.2] , Heidi G. De Souza [sup.3] , Kathleen Mallett [sup.4] , Melisha G. Hanna [sup.5] , Troy Richardson [sup.3] , Megan [...]

Background The blood pressure (BP) burden is high in pediatric hemodialysis (HD) patients and adversely affects prognosis. The aim of this study was to examine whether 44-h ambulatory BP monitoring (ABPM) provides additional relevant BP data compared with 24-h ABPM. Methods ABPM was initiated at the end of the mid-week dialysis run in 13 stable pediatric HD patients and continued until the next run for 44 h. Day 1 was defined as the initial 24-h ABPM and Day 2 as the time period after that until the next dialysis run. All patients had an echocardiogram to calculate the left ventricular mass index (LVMI). Results A higher percentage of patients were diagnosed with hypertension from the 44-h ABPM than from the 24-h ABPM. All BP indexes and loads (except nighttime diastolic load) were significantly higher on Day 2 than on Day 1. Patients with BP loads of >25 % on 44-h ABPM had significantly higher LVMI than those patients with normal BP loads. No such association was found with 24-h ABPM and LVMI. Higher interdialytic weight gain was associated with higher Day-2 nighttime systolic BP load. Conclusions The 44-h ABPM provides more information than the 24-h ABPM in terms of diagnosing and assessing the true burden of hypertension in pediatric HD patients. Elevated BP loads from 44-h ABPM correlate with a higher LVMI on the echocardiogram. Keywords Hypertension * Dialysis * Pediatric nephrology * Blood pressure * Ambulatory blood pressure monitoring, Introduction Hypertension (HTN) is a significant risk factor for cardiovascular disease in children with end-stage renal disease receiving dialysis [1]. Despite significant efforts to diagnose and treat HTN, blood pressure [...]

The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multi-center quality transformation effort whose primary aim is to minimize exit-site infection and peritonitis rates among pediatric chronic peritoneal dialysis patients. The project, developed by the quality improvement faculty and staff at the Children's Hospital Association's Quality Transformation Network (QTN) and content experts in pediatric nephrology and pediatric infectious diseases, is modeled after the QTN's highly successful Pediatric Intensive Care Unit and Hematology-Oncology central line-associated blood-stream infection (CLABSI) Collaboratives. Like the Association's other QTN efforts, the SCOPE Collaborative is part of a broader effort to assist pediatric nephrology teams in learning about and using quality improvement methods to develop and implement evidence-based practices. In addition, the design of this project allows for targeted research that builds on high-quality, ongoing data collection. Finally, the project, while focused on reducing peritoneal dialysis catheter-associated infections, will also serve as a model for future pediatric nephrology projects that could further improve the quality of care provided to children with end stage renal disease. Keywords Pediatric . Dialysis . Peritonitis . Infection . Improvement, Introduction Chronic peritoneal dialysis (CPD) is the most common dialysis modality utilized for children with end stage renal disease (ESRD) worldwide [1, 2]. Peritoneal dialysis (PD) catheter-related infections, including exit-site [...]

Background We hypothesized that the percent change in resistance (%RΔ) from bioimpedance analysis (BIA) measurements during hemodialysis (HD) can provide information on pediatric HD patients' hydration status. Methods Whole-body single-frequency BIA measurements were obtained before HD, each hour on HD, and after HD during two HD sessions. Pre-and post-HD weights, blood pressures, Crit-Line® measurements, and intradialytic symptoms were collected on the day of the BIA measurements. Results One hundred and thirty BIA measurements were obtained from 14 HD patients. The group was 43% girls, and the mean age was 13.2 ± 4.4 years. Percent change in resistance was 13.5 ± 10.8% at the end of HD; %RΔ correlated with percent body weight change (%BWΔ) following HD (r= -0.83, P Conclusions Our study showed that %RΔ strongly correlates with %BWA and %BVΔ and that %RΔ also correlated with intradialytic symptoms and LVMI. Keywords Bioimpedance * Resistance * Hemodialysis * Fluid * Hydration * Dry weight * Pediatric, Introduction Cardiovascular disease is the leading cause of mortality in pediatric patients on dialysis [1]. Chronic hypervolemia in dialysis patients has been associated with increased left ventricular mass (LVM), hypertension [...]