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Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry

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Abstract

Background

Chronic haemodialysis (HD) in small children has not been adequately investigated.

Methods

This was a retrospective investigation of the use of chronic HD in 21 children aged  <2 years (n = 12 aged <1 year) who were registered in the Italian Pediatric Dialysis Registry. Data collected over a period of >10 years were analysed.

Results

The median age of the 21 children at start of HD was 11.4 [interquartile range (IQR) 6.2–14.6] months, and HD consisted mainly of haemodiafiltration for 3–4 h in  ≥4 sessions/week. A total of 51 central venous catheters were placed, and the median survival of tunnelled and temporary lines was 349 and 31 days, respectively (p  < 0.001). Eight children (38 %) showed evidence of central vein thrombosis. Although 19 % of patients received growth hormone and 63.6 % received enteral feeding, the weight and height of these patients remained suboptimal. During the HD period the haemoglobin level increased in all patients, but not to normal levels (from 8.5 to 9.6 g/dl) despite erythropoietin administration (503–600 U/kg/week). The hospitalisation rate was 1.94/patient-year. Seventeen patients underwent renal transplantation at a median age of 3.0 years. Four patients, all affected by severe comorbidities, died during follow-up (in 2 cases due to absence of a vascular access). The 5- and 10-year cumulative survival was 82.4 and 68.7 %, respectively.

Conclusions

Extracorporeal dialysis is feasible in children aged  <2 years, but comorbidities, vascular access, growth and anaemia remain major concerns.

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Authors and Affiliations

  1. Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy

    Fabio Paglialonga, Silvia Consolo & Alberto Edefonti

  2. Nephrology and Dialysis Unit, Santobono Children’s Hospital, Naples, Italy

    Carmine Pecoraro & Maria Teresa Saravo

  3. Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women’s and Children’s Health, University Hospital Padua, Padua, Italy

    Enrico Vidal

  4. Nephrology Dialysis and Transplantation Unit, Regina Margherita University Hospital, Turin, Italy

    Bruno Gianoglio

  5. Nephrology Division, Giovanni XXIII Children’s Hospital, Bari, Italy

    Flora Puteo

  6. Nephrology and Dialysis Unit, Department of Nephrology-Urology, IRCCS “Bambino Gesù” Children’s Hospital, Rome, Italy

    Stefano Picca

  7. Dialysis Unit, Paediatric Nephrology and Dialysis Department, IRCCS Giannina Gaslini Institute, Genoa, Italy

    Enrico Verrina

Authors
  1. Fabio Paglialonga
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  2. Silvia Consolo
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  3. Carmine Pecoraro
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  4. Enrico Vidal
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  5. Bruno Gianoglio
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  6. Flora Puteo
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  7. Stefano Picca
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  8. Maria Teresa Saravo
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  9. Alberto Edefonti
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Correspondence to Fabio Paglialonga.

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Paglialonga, F., Consolo, S., Pecoraro, C. et al. Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry. Pediatr Nephrol 31, 833–841 (2016). https://doi.org/10.1007/s00467-015-3272-6

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  • DOI: https://doi.org/10.1007/s00467-015-3272-6

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