Current advances in the therapy of chronic renal failure and end stage renal disease.

The improved outcomes recently experienced by children with chronic renal failure and end stage renal disease (ESRD) does not obviate the need to strive to better the quality of their physical, mental and emotional well-being. This article reviews some of the recent advances in the care of these children that are intended to achieve that goal. Dialysis topics include prescription, novel solutions, adequacy measures, management of anemia, and access. Transplantation areas covered include graft and patient survival, growth, organ availability, opportunistic infections and immunity, immunosuppressive agents, and transplant-related malignancies. The care of the pre-ESRD patient is discussed with a review of new data that are being compiled in this patient population.