Hemodialysis in children with end-stage renal disease.

Although renal transplantation remains the most common treatment for children with end-stage renal disease (ESRD), the majority of children incident to ESRD receive dialytic therapy before receiving a renal allograft. Advances in the past decade have led to improved outcomes for children receiving maintenance hemodialysis, the majority of whom survive into adulthood. Medical, surgical, nutritional and psychosocial factors must be considered to provide optimal maintenance hemodialysis for children. In this Review, we discuss the various aspects of providing optimal hemodialysis to children, including vascular access, nutritional status, clearance targets, medications and assessment of health-related quality of life.