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Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes

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Abstract

Background

Hemodialysis (HD) in children with a concomitant ventriculoperitoneal shunt (VPS) is rare. Registry data suggest that peritoneal dialysis with a VPS is safe, but little is known about HD in the presence of a VPS.

Methods

We performed a 10-year survey to determine the prevalence of a VPS, complications and outcome in children with a VPS on HD in 15 dialysis units from the 13 countries participating in the European Pediatric Dialysis Working Group.

Results

Eleven cases of HD with a VPS were reported (prevalence 1.33 %; 328 patient-months) and compared with prospective Registry data. The median age at start of dialysis was 9.6 [inter-quartile range (IQR) 1.0–15.0] years and median HD vintage was 2.4 (IQR 1.7–3.0) years. Dialysis was performed through a central venous line (CVL) and through an arteriovenous fistula in six and five children, respectively. Three CVL infections occurred in two children, but these children did not develop VPS infections or meningitis. Symptoms of hemodynamic instability were reported in six (55 %) children at least once per week, with hypotension or hypertension occurring in four of these children and nausea, vomiting and headaches occurring in two; four other children reported less frequent symptoms. Seizures on dialysis occurred in two children, at a frequency of less than once per month, with one child also experiencing visual disturbances. During follow-up (median 4.0; IQR 0.38–7.63 years), three children remained on HD and eight had a functioning transplant. No patients were switched to PD.

Conclusions

Hemodialysis in children with a VPS is safe, but associated with frequent symptoms of hemodynamic instability. No episodes of VPS infection or meningitis were seen among the children in the survey, not even in those with CVL sepsis.

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Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK

    Elizabeth Wright, Stephanie Dufek & Rukshana Shroff

  2. Hopital de Hautepierre, Strasbourg, France

    Michel Fischbach & Ariane Zaloszyc

  3. Fondazione IRCCS Ca’ Grande Ospedale Maggiore Policlinico, Milan, Italy

    Fabio Paglialonga & Alberto Edefonti

  4. University Hospital of Vienna, Vienna, Austria

    Christoph Aufricht

  5. Ankara University Hospital, Ankara, Turkey

    Sevcan Bakkaloğlu

  6. KfH Pediatric Kidney Center, Marburg, Germany

    Günter Klaus

  7. Gdansk University Medical School, Gdansk, Poland

    Aleksandra Zurowska

  8. Gazi University Hospital, Ankara, Turkey

    Mesiha Ekim

  9. University Hospital Vall d’Hebron, Barcelona, Spain

    Gema Ariceta

  10. University of Helsinki, Helsinki, Finland

    Tuula Holtta

  11. Vilnius University, Vilnius, Lithuania

    Augustina Jankauskiene

  12. Center for Pediatric & Adolescent Medicine, Heidelberg, Germany

    Claus Peter Schmitt

  13. “A & P Kyriakou”, Children’s Hospital, Athens, Greece

    Constantinos J. Stefanidis

  14. Universitair ziekenhuis Gent, Ghent, Belgium

    Johan Vande Walle

  15. University Hospital Motol, Prague, Czech Republic

    Karel Vondrak

Authors
  1. Elizabeth Wright
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  2. Michel Fischbach
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  3. Ariane Zaloszyc
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  4. Fabio Paglialonga
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  7. Sevcan Bakkaloğlu
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  8. Günter Klaus
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  11. Gema Ariceta
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  12. Tuula Holtta
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  13. Augustina Jankauskiene
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  14. Claus Peter Schmitt
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  15. Constantinos J. Stefanidis
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  16. Johan Vande Walle
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  18. Alberto Edefonti
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  19. Rukshana Shroff
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on behalf of the European Paediatric Dialysis Working Group

Corresponding author

Correspondence to Rukshana Shroff.

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Wright, E., Fischbach, M., Zaloszyc, A. et al. Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes. Pediatr Nephrol 31, 137–143 (2016). https://doi.org/10.1007/s00467-015-3204-5

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  • DOI: https://doi.org/10.1007/s00467-015-3204-5

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