Predictors of dialysis adequacy in pediatric nephrology patients with nephrolithiasis

Zola Ndlovu; T. Osei; T. Kamau

doi:10.5281/zenodo.22813100

Authors

Zola Ndlovu Department of Clinical Renal Medicine, Uruguay Center for Nephrology Author https://orcid.org/7812-2224-5502-8026
T. Osei Department of Nephrology, Ebro Institute for Advanced Renal Medicine Author https://orcid.org/4059-2966-9000-7103
T. Kamau Division of Renal Medicine, Tiber Academy of Nephrology Author https://orcid.org/5030-1409-7075-1700

DOI:

https://doi.org/10.5281/zenodo.22813100

Keywords:

dialysis adequacy, pediatric nephrology, nephrolithiasis, Kt/V, chronic kidney disease

Abstract

Graphical abstract

Background: Nephrolithiasis is increasingly recognized in children with chronic kidney disease, and its influence on dialysis adequacy once these patients reach kidney failure is poorly characterized.

Objective: To identify predictors of dialysis adequacy, defined by Kt/V and normalized protein catabolic rate, in pediatric patients with nephrolithiasis on chronic dialysis.

Methods: Retrospective cohort of 118 pediatric dialysis patients (74 hemodialysis, 44 peritoneal dialysis) with confirmed nephrolithiasis across three centers (2019-2025). Adequacy was assessed for 12 months; multivariable regression identified independent predictors.

Results: Adequate dialysis was achieved in 71.2% of measurements. Residual kidney function (adjusted OR 2.84), higher body mass index z-score (adjusted OR 1.62), arteriovenous fistula access (adjusted OR 3.21), and recurrent stone episodes (adjusted OR 0.46) were independent predictors. Bicarbonate and normalized protein catabolic rate correlated positively with achieved Kt/V (r=0.41, r=0.53; p<0.001).

Conclusion: Dialysis adequacy in pediatric nephrolithiasis patients is shaped by residual renal function, nutrition, vascular access, and stone recurrence, supporting targeted surveillance and access planning in this population.

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