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February 27, 2001
MEDIA CONTACT: David Bricker
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Study: Specialization Affects Recommendation of Kidney Failure Treatment

Pediatric kidney specialists are 60 percent more likely than their peers who treat adults to recommend peritoneal dialysis over hemodialysis, report Johns Hopkins Children’s Center researchers in this week’s Journal of the American Medical Association. Although most of the approximately 5,000 children and teens living with end_stage renal disease (ESRD) in the United States are seen by pediatric nephrologists, many are treated by adult nephrologists.

"If you’re the parent of a teenager with kidney disease, you should be aware that the recommendation you get for dialysis may depend on whether you go to a pediatric or adult_trained nephrologist," says the study’s lead author, pediatric nephrologist Susan Furth, M.D., Ph.D. Furth says treatment choice "can affect a patient’s quality of life."

Hemodialysis and peritoneal dialysis are therapies that remove toxins from the bloodstream, a job normally handled by healthy kidneys. When kidney function falls about 10 percent, dialysis may become necessary to compensate for the loss of kidney function. Hemodialysis requires a patient to visit a clinic or hospital three times a week for three_hour sittings, often during school hours, while blood is cleansed through a large machine. Peritoneal dialysis, on the other hand, can be regulated and maintained at home or at school because it consists of portable equipment children and teens can carry with them.

From a national survey of 316 nephrologists nationwide, Furth learned that doctors with a high degree of pediatric experience were much more likely to recommend peritoneal dialysis over its alternative, hemodialysis, for young patients with ESRD.

While the relative benefits of peritoneal dialysis and hemodialysis have not yet been evaluated under controlled study, Furth says anecdotal evidence has led most pediatric nephrologists to recommend peritoneal dialysis as the preferred option for children and adolescents. "Many pediatricians have reported a higher quality of life and better growth and school attendance for kids on peritoneal dialysis than on hemodialysis," Furth says.

Many children with ESRD don’t have the option of visiting a children’s specialist, since pediatric nephrologists tend to concentrate around urban areas and medical research centers, says Furth. As a result, many children with kidney problems visit adult nephrologists.

Researchers at the Johns Hopkins Departments of Health Policy and Management, Epidemiology and the School of Medicine also contributed to the study. It was funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and from the Johns Hopkins Children’s Center Clinical Care Outcomes Research Project.

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