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

Abstract

This study reviews medical and psychosocial patients with end-stage renal disease ( ESRD). In chil- rehabilitation of children and adolescents with end- dren 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 long- receiving renal replacement therapy ( RRT ) since child- term consequences of coping with the burdens of hood were analysed . Medical and psychosocial rehabil- chronic illness in childhood, and ( 2) decisions regard- itation 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 con- an aged-matched control population (n=26) with long- cerning 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 trans- rehabilitation 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 hyperten- patients in Europe (6 ). However, data from individual sion, left ventricular hypertrophy, anaemia, osteodys- centres 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 con- data 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