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

Pediatric Nephrology volume 31, pages 137–143 (2016)Cite this article

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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References

  1. Kato N, Chin-Kanasaki M, Tanaka Y, Yusuda M, Yokomaku Y, Sakaguchi M, Isshiki K, Araki S, Ohta S, Uzu T (2011) Successful renal replacement therapy for a patient with severe haemophilia after surgical treatment of intercranial haemorrhage and hydrocephalus. Case Rep Nephrol 2011: 824709

  2. Grunberg J, Rebori A, Verocay MC (2003) Peritoneal dialysis in children with spina bifida and ventriculoperitoneal shunt: one center’s experience and review of the literature. Perit Dial Int 23:481–486

    PubMed  Google Scholar 

  3. Grunberg J, Verocay MC, Rebori A, Pouso J (2007) Comparison of chronic peritoneal dialysis outcomes in children with and without spina bifida. Pediatr Nephrol 22:573–577

    Article  PubMed  Google Scholar 

  4. Thet Y, Myint W, Hughes D, Crowe AV (2008) Ventriculo-peritoneal shunt infection in a patient on hemodialysis. Hemodial Int 12:319–321

    Article  PubMed  Google Scholar 

  5. Dolan NM, Borzych-Duzalka D, Suarez A, Principi I, Hernadez O, Al-Akash S, Alconchar L, Breen C, Fischbach M, Flynn J, Pape L, Piantanida JJ, Printza N, Wong W, Zaritsky J, Schaefer F, Warady BA, White CT (2013) Ventriculoperitoneal shunts in children on peritoneal dialysis: a survey of the International Pediatric Peritoneal Dialysis Network. Pediatr Nephrol 28:315–319

    CAS  Article  PubMed  Google Scholar 

  6. Warady BA, Hellerstein S, Alon U (1990) Advisability of initiating chronic peritoneal dialysis in the presence of a ventriculoperitoneal shunt. Pediatr Nephrol 4:96

    CAS  Article  PubMed  Google Scholar 

  7. Wang H-Y, Lin W-Y (2010) An unusual iatrogenic cerebrospinal fluid leakage from ventriculoperitoneal shunt. Ann Nucl Med Sci 23:59–63

    Google Scholar 

  8. Sands J, Usvyat L, Sullivan T, Segal J, Zabetakis P, Kotanko P, Maddux F, Diaz-Buxo J (2014) Intradialytic hypotension: frequency, sources of variation and correlation with clinical outcome. Hemodial Int 18:415–422

    Article  PubMed  Google Scholar 

  9. Stefansson B, Brunelli S, Cabrera C, Rosenbaum D, Anum E, Ramakrishnan K, Jensen D, Stalhammar N (2014) Intradialytic hypotension and risk of cardiovascular disease. Clin J Am Soc Nephrol 9:2124–2132

    Article  PubMed  Google Scholar 

  10. Hayes W, Hothi D (2011) Intradialytic hypotension. Pediatr Nephrol 26:867–879

    Article  PubMed  Google Scholar 

  11. Hothi D, Rees L, Marek J, Burton J, McIntyre C (2009) Pediatric myocardial stunning underscores the cardiac toxicity of conventional hemodialysis treatments. Clin J Am Soc Nephrol 4:790–797

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  12. Locatelli F, Altieri P, Andrulli S, Bolasco P, Sau G, Pedrini L, Basile C, David S, Feriani M, Montagna G, Raffaele di Iorio B, Memoli B, Cravero R, Battaglia G, Zocalli C (2010) Hemofiltration and haemodiafiltration reduce intradialytic hypotension in ESRD. J Am Soc Nephrol 21:1798–1807

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  13. Caplin B, Alston H, Davenport A (2013) Does online haemodiafiltration reduce intra-dialytic patient symptoms? Nephron Clin Pract 124:184–190

    Article  PubMed  Google Scholar 

  14. Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line haemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367

    Article  PubMed  Google Scholar 

  15. Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) Daily online haemodiafiltration promotes catch-up growth in children on chronic dialysis. Pediatr Nephrol 25:867–873

    CAS  Article  Google Scholar 

  16. Hothi D, Harvey E, Goia CM, Geary D (2009) The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure. Pediatr Nephrol 24:1587–1591

    Article  PubMed  Google Scholar 

  17. Greenberg MS (2010) Handbook of neurosurgery, 7th edn. Thieme, Stuttgart

  18. Stein S, Guo W (2007) A mathematical model of survival in a newly inserted ventricular shunt. J Neurosurg Pediatr 107:448–454

    Article  Google Scholar 

  19. Wu Y, Green N, Wrensch M, Zhao S, Gupta N (2007) Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery 61:557–562

    Article  PubMed  Google Scholar 

  20. Shroff R, Stefanidis CJ, Askiti V, Edefonti A, Testa S, Ekim M, Kavaz A, Ariceta G, Bakkaloglu S, Fischbach M, Klaus G, Zurowska A, Holtta T, Jankauskiene A, Vondrak K, Vande Walle J, Schmitt CP, Watson AR, on behalf of the European Pediatric Dialysis Working Group (2013) Encapsulating peritonitis sclerosis in children on chronic PD: a survey from the European Pediatric Dialysis Working Group. Nephrol Dial Transplant 28:1908–1914

    CAS  Article  PubMed  Google Scholar 

  21. Stefanidis CJ, Shroff R (2014) Encapsulating peritoneal sclerosis in children. Pediatr Nephrol 29:2093–2103

    Article  PubMed  Google Scholar 

  22. Sigaroudinia MO, Baillie C, Ahmed S, Mallucci C (2008) Sclerosing encapsulating peritonitis—a rare complication of ventriculoperitoneal shunts. J Pediatr Surg 43:E31–E33

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare no conflict of interest.

Author information

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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  5. Christoph Aufricht
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  6. Stephanie Dufek
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  7. Sevcan Bakkaloğlu
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  8. Günter Klaus
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  9. Aleksandra Zurowska
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  10. Mesiha Ekim
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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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  17. Karel Vondrak
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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

Keywords

  • Hemodialysis
  • Ventriculoperitoneal shunt
  • Children
  • Central venous line
  • Seizures