The impact of the Dialysis Outcomes Quality Initiative Guidelines on the care of the pediatric end-stage renal disease patient.

The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) Guidelines for hemodialysis and peritoneal dialysis adequacy, management of vascular access, and management of anemia are based primarily on evidence derived from the experience of adult dialysis patients. However, these Guidelines can also be used to improve the care of children with end-stage renal disease (ESRD). Some of the guidelines are directly applicable to pediatric dialysis patients, such as the preferential use of the internal jugular vein for placement of a central venous catheter for dialysis. Other Guidelines, such as targets for adequacy of hemodialysis and peritoneal dialysis, serve as minimal standards of care for children with little supporting data specific to pediatrics. The importance of early referral and proactive care for children and adults with chronic renal failure is emphasized in all of the Guidelines. Optimum care should include early discussion of transplantation and choice of dialysis modality, preservation of sites for future vascular access, and early attention to anemia and nutrition. Clinical algorithms should be developed to implement the current Guidelines while data are generated to support modification of any of the recommendations for children.