Medical and psychosocial rehabilitation of young adults receiving renal replacement therapy since childhood: a single-centre experience.

This study reviews medical and psychosocial patients with end-stage renal disease (ESRD). In chilrehabilitation of children and adolescents with enddren and adolescents with ESRD, medical problems stage renal disease (ESRD) and analyses data of young with the exception of growth are in many ways similar adults with ESRD from a single centre providing renal to those encountered in adult patients. In contrast, replacement therapy (RRT) for more than 20 years. psychosocial rehabilitation in young patients is an issue Data from 30 patients, aged 25±4 (18–34) years of special importance mainly because of (1) the longreceiving renal replacement therapy (RRT) since childterm consequences of coping with the burdens of hood were analysed . Medical and psychosocial rehabilchronic illness in childhood, and (2) decisions regarditation were assessed by a medical questionaire and by ing schooling, marriage, job training, and employment. chart review. The sociological data were compared to Only few centres have published their experience conan aged-matched control population (n=26) with longcerning long-term rehabilitation of young adults who standing diabetes mellitus type I (DM ) and to the have received renal replacement therapy (RRT) since available national demographic data. Seventeen childhood [1–3]. The EDTA has recently published patients were treated by dialysis (D) and 13 by transrehabilitation data obtained from 617 patients between plantation (TPL). The duration of RRT was 13 (1–21) the ages of 21 and 35 years [4,5] and the collected years. Growth failure was pronounced in most patients, demographic information on over 8000 young RRT and a significant number were suffering from hypertenpatients in Europe [6]. However, data from individual sion, left ventricular hypertrophy, anaemia, osteodyscentres can provide important additional information trophy, hepatitis, and physical disabilities. Vocational obtained in a more homogeneous population. training/school performance, and employment was not We had the unique opportunity to collect data on markedly different in patients with RRT and controls medical and psychosocial rehabilitation from a single with DM. However, the type of employment was centre with over 20 years of experience with RRT in different with an overrepresentation of lower-income children. A programme for haemodialysis, peritoneal jobs in RRT patients. Most patients with RRT were unmarried and one-third was living with their parents. dialysis, and renal transplantation integrated with These data, largely reflecting early experience of a a psychosocial support team was initiated at the paediatric RRT programme, indicate that young adults University Children’s Hospital of Cologne in 1972, receiving RRT from childhood have a multitude of being one of the earliest in Europe. In interpreting the medical and psychosocial problems, providing a condata it must be remembered that these largely reflect tinuing challenge for centres providing RRT. a learning experience starting in the beginning years of paediatric RRT—and incorporating the advances