[25 years kidney replacement therapy in childhood and adolescence--success of somatic and psychosocial rehabilitation].

In the late sixties, renal replacement therapy (RRT) was started in terminal renal insufficient children and adolescents. The high mortality rate and extreme therapeutic difficulties gave doubts to the possibility of longterm survival as well as somatic and psychosocial rehabilitation in these patients. But nowadays due to improvements in medical and technical possibilities of dialysis and kidney transplantation as well as to individually adapted treatment of the metabolic problems 5-years survival rate is more than 90%, body growth and development is in the lower normal range. Successful psychosocial rehabilitation despite RRT has also improved over time. In the beginning only 29% dialysed patients and 51% transplanted children attended school and 65% completed school. A recent analysis of educational status employment rate and social situation in 617 patients between 20 and 35 year of age who started RRT as children in Europe and 276 terminal renal insufficient adolescents in Germany, gave following results: one third went to vocational training, 11-17% attended university. Thereafter 40-65% of all patients were employed. Unemployment was a big problem in dialysed adolescents and young adults. With increasing age the patients gained independence in their life style. About 20% lived in their own houses, 28% were either married, divorced or widowed, 8% had children of their own.