Abstract
Despite significant technical improvements, hemodialysis in infants with end-stage renal disease (ESRD) is still associated with significant morbidity and mortality. The files of patients weighing less than 15 kg with ESRD who were treated with hemodialysis at our institute between 1995 and 2005 were reviewed for background and treatment characteristics, morbidity and outcome. The study group included 11 patients aged 7–75 months (mean 34.2 months) weighing 7.2–14.9 kg (mean 10.9 kg). Mean duration of dialysis was 11.3 months. Vascular access posed the major problem. Ten patients were dialyzed through a central venous cuffed catheter and one through an arteriovenous fistula. An average of three different vascular accesses was required per patient (range 1–9). Mechanical difficulties were the most common cause of central-line removal (56.5%), followed by infections (15.6%). Major complications causing significant morbidity were intradialytic hemodynamic instability, hyperkalemia, coagulation within the dialysis set, anemia, hypertension, inadequate fluid removal, and recurrent hospitalizations. Analysis of outcome revealed that eight patients underwent successful transplantation, one returned for hemodialysis after 4.5 years due to graft failure, and two died. Hemodialysis is a suitable option for low-weight pediatric patients with ESRD awaiting transplantation when performed in highly qualified centers.
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References
U.S. Renal Data System (2006) USRDS 2006 annual data report. Atlas of end-stage renal disease in the United States. National Institute of Diabetes, Digestive and Kidney Disease
Neu AM, Ho PL, McDonald RA, Warady BA (2002) Chronic dialysis in children and adolescents. The 2001 NAPRTCS Annual Report. Pediatr Nephrol 17:656–663
Warady BA, Hebert D, Sullivan EK, Alexander SR, Tejani A (1997) Renal transplantation, chronic dialysis, and chronic renal insufficiency in children and adolescents. The 1995 Annual Report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 11:49–64
Warady BA, Alexander SR, Watkins S, Kohaut E, Harmon WE (1999) Optimal care of the pediatric end-stage renal disease patients on dialysis. Am J Kidney Dis 33:567–583
Cochat P, Linoux C (2004) Maintenance hemodialysis during infancy. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds) Pediatric dialysis, 1st edn. Kluwer Academic, Dordrecht, pp 197–208
US Renal Data System: USRDS 1999 annual report (1999) Pediatric end-stage renal disease. Am J Kidney Dis 34(Suppl 2):S102–S103
Wood EG, Hand M, Briscoe DM, Donaldson LA, Yiu V, Harley FL, Warady BA, Ellis EN, North American Pediatric Renal Transplant Cooperative Study (2001) Risk factors for mortality in infants and young children on dialysis. Am J Kidney Dis 37:573–579
Al-Hermi BE, Al-Saran K, Secker D, Geary DF (1999) Hemodialysis for end-stage renal disease in children weighing less than 10 kg. Pediatr Nephrol 13:401–403
Shroff R, Wright E, Lederman S, Hutchinson C, Rees L (2003) Chronic hemodialysis in infants and children under 2 years of age. Pediatr Nephrol 18:378–383
Shroff R, Rees L, Trompeter R, Hutchinson C, Lederman S (2006) Long term outcome of chronic dialysis in children. Pediatr Nephrol 21:257–264
Sheth RD, Brandt ML, Brewer ED, Nuchtern JG, Kale AS, Goldstein SL (2002) Permanent hemodialysis vascular access survival in children and adolescents with end-stage renal disease. Kidney Int 62:1864–1869
Geary DF (1998) Attitudes of pediatric nephrologists to management of end-stage renal disease in infants. J Pediatr 133:154–156
NKF-K/DOQI (2001) Clinical practice guidelines for vascular access: update 2000. Am J Kidney Dis 37:S137–S181
Goldstein SL, Macierowski CT, Jabs K (1997) Hemodialysis catheter survival and complications in children and adolescents. Pediatr Nephrol 11:74–77
Lumsden AB, MacDonald MJ, Allen RC, Dodson TF (1994) Hemodialysis access in the pediatric patient population. Am J Surg 168:197–201
Marr KA, Sexton DJ, Conlon PJ, Corey GR, Schwab SJ, Kirkland KB (2000) Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis. Ann Intern Med 127:275–280
Yorgin PD, Al-uzri A (2004) Recombinant human erythropoietin therapy. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds) Pediatric dialysis, 1st edn. Kluwer Academic, Dordrecht, pp 197–208
Leonard MB, Donaldson LA, Ho M, Geary DF (2003) A prospective cohort study of incident maintenance dialysis in children: a NAPRTC study. Kidney Int 63:744–755
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Kovalski, Y., Cleper, R., Krause, I. et al. Hemodialysis in children weighing less than 15 kg: a single-center experience. Pediatr Nephrol 22, 2105–2110 (2007). https://doi.org/10.1007/s00467-007-0614-z
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DOI: https://doi.org/10.1007/s00467-007-0614-z