Audit of Hemodialysis in Children Weighing Less than 20 kg in an African Pediatric Nephrology Unit

Abstract

Peritoneal dialysis and kidney transplantation remain the preferred choices for renal replacement therapy in young children. These options, however, are not always feasible, and hemodialysis (HD) is therefore an accepted alternative. In small children presenting with end-stage renal disease, HD presents several challenges and is often unavailable in lower- and middle-income countries. To assess these challenges and outcomes of maintenance HD in young children, we performed an audit of children below 20 kg with end-stage renal disease, receiving HD for ≥4 weeks, from 1 January 2008 to 31 July 2016 at the Red Cross War Memorial Children's Hospital. We identified 15 children weighing 6.8-18.5 kg (mean 12.9 kg ±3.5 SD) and aged 11.5-105 months (mean 52.2 months±4.2 SD) at HD initiation. Mean duration of HD was 11.8 months (range 1-61.5 months ± 16.9 SD). Seven children underwent successful transplantation, two patients died, and four currently still receive HD. Two patients, while on HD, relocated to other centers. An average of 2.6 (range 1-5) different vascular accesses was required per patient. Technical difficulties were the most common cause of central-line removal (81%), while catheter-associated bacteremia was 1.1/1000 catheter days. Frequent problems were intradialytic hypotension, growth stunting, and interdialytic hypertension. HD in lower- and middle-income countries is feasible in small children but presents with certain challenges. Advocacy with lobbying for funding and development of "child-friendly" dialysis equipment and specialized centers with highly skilled personnel are the cornerstones of successful pediatric HD programs in less-resourced centers.

Survival of Tunneled Double Lumen-Cuffed Catheters in Children on Maintenance Hemodialysis – A Retrospective Cohort Study

“…The CRBSI rate in our study was 1.19 per 1000 catheter days, which was comparable to those reported in many other studies [ Table 4 ]. [ 2 13 14 ] In the study by Goldstein et al ,[ 24 ] the CRBSI rate was 0.71 per patient year and was the cause for catheter failure in 36% of cases with no related mortality. The low prevalence had been attributed to strict adherence to aseptic protocols.…”

“…[ 2 ] Reports from single center studies show a heterogeneous outcome with some reporting catheter survival rates in middle and low-income countries to be comparable to those in high-income countries, while others have reported higher rates of CRBSI or shorter catheter survival rates. [ 9 13 14 ]…”

Long-term Patency of Arteriovenous Fistulas as a Vascular Access in Paediatric Age Group Patients with End-stage Renal Disease-Egyptian experience

“…The age of all patients was less than 6 years, weight of 160 children (86.4%) was below 20 Kg, and 40% were below the 25th percentile similar to Keenswijk's study. 22 Renal transplantation is still the preferred treatment for paediatric patients with ESRD in order to avoid increased morbidity and mortality. 23,26 The kidney transplant waiting list in our institute is quite long, it can occasionally stretch for years owing to many factors such as a scarcity of suitable organ donors.…”

“…Access-related infection is defined as local erythema, abscess, or edoema at the fistula site that requires antibiotics. 20,22 SPSS (Version 25.0, IBM SPSS Statistics for Windows, IBM Corp. Released 2017.)…”

A novel recyclable hemoperfusion adsorbent based on TiO2nanotube arrays for the selective removal of β2-microglobulin

“…However, the preparation process is complex, and the price is high, which limits the application of immunosorbents in many developing countries. [12][13][14] Therefore, the development of a new specific b 2 m adsorbent with good hemocompatibility and low cost is urgently needed to reduce the cost of b 2 m treatment in developing countries.…”