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Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome

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Abstract

Background

Peritoneal dialysis is the preferred mode of renal replacement therapy in infants with end-stage renal disease (ESRD). Hemodialysis (HD) is seldom used in neonates and infants due to the risk of major complications in the very young.

Methods

Demographic, clinical, laboratory, and imaging data on all infants younger than 12 months with ESRD who received HD in our Pediatric Dialysis Unit between January 1997 and June 2013 were analyzed.

Results

Eighteen infants (n = 6 male) with ESRD (median age 3 months; median weight 4.06 kg) received HD through a central venous catheter (CVC) for a total of 543 months (median duration per infant 16 months). Seven of the infants (39 %) were neonates, and five (28 %) had serious comorbidities. There were five episodes of CVC infection, which is a rate of 0.3/1000 CVC days. Median catheter survival time was 320 days. Most infants had good oral intake, and only four (22 %) required a gastric tube; 14 (78 %) infants displayed normal growth. Fourteen (78 %) infants had hypertension, of whom four (22 %) had severe cardiac complications; eight (44 %) showed delayed psychomotor development. Eleven (61 %) of the infants, including six (86 %) of the neonates, survived. Five (28 %) infants underwent renal transplantation; 10-year graft survival was 80 %.

Conclusions

Based on these results, long-term HD in neonates and infants with ESRD is technically feasible, can be implemented without major complications, carries a very low rate of CVC infection and malfunction, and results in adequate nutrition, good growth, as well as good kidney graft and patient survivals. Future efforts should aim to prevent hypertension and its cardiac sequelae, improve neurodevelopmental outcome, and lower mortality rate in these infants.

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Acknowledgments

We gratefully acknowledge the dedication and assistance of our Pediatric Dialysis Unit staff and the medical and nursing staff of the Pediatric Intensive Care Unit and Ruth Rappaport Children’s Hospital throughout the years of the study.

Conflict of interests

None declared.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel

    Shirley Pollack, Israel Eisenstein, Mahdi Tarabeih, Hadas Shasha-Lavski, Daniella Magen & Israel Zelikovic

  2. Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel

    Shirley Pollack, Israel Eisenstein, Daniella Magen & Israel Zelikovic

Authors
  1. Shirley Pollack
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  2. Israel Eisenstein
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  3. Mahdi Tarabeih
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  4. Hadas Shasha-Lavski
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  5. Daniella Magen
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  6. Israel Zelikovic
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Correspondence to Israel Zelikovic.

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Pollack, S., Eisenstein, I., Tarabeih, M. et al. Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome. Pediatr Nephrol 31, 305–313 (2016). https://doi.org/10.1007/s00467-015-3214-3

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  • DOI: https://doi.org/10.1007/s00467-015-3214-3

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