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

Paglialonga, Fabio; Consolo, Silvia; Pecoraro, Carmine; Vidal, Enrico; Gianoglio, Bruno; Puteo, Flora; Picca, Stefano; Saravo, M. T.; Edefonti, Alberto; Verrina, Enrico

doi:10.1007/s00467-015-3272-6

Cited by 22 publications

(24 citation statements)

References 25 publications

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“…Subcutaneous tunneling and the cuff itself make these catheters more secure and may provide a barrier to bacterial infection . However, some authors have reported revision rates similar to ours despite the use of cuffed catheters . Also, since two catheters were still functioning at the end of the study period, but were considered as “end of function” in the statistical calculation, the median time of line function was actually better than reported.…”

Section: Discussionsupporting

confidence: 59%

“…This could be ascribed to the use of uncuffed catheters in our patients as in all other studies mainly cuffed tunneled catheters were used. Cuffed CVCs have been associated with significantly improved catheter longevity as compared to uncuffed catheters . Subcutaneous tunneling and the cuff itself make these catheters more secure and may provide a barrier to bacterial infection .…”

Section: Discussionsupporting

confidence: 57%

“…The preference of PD as the initial treatment option for maintenance dialysis in infants and young children is commonplace worldwide, and HD is used only when PD fails or is inapplicable for social or anatomic reasons . Paglialonga et al reported that chronic HD represented the first‐choice dialysis modality in only 6% of cases in a cohort of children younger than 2 years of age, which compares to previously published frequencies of 3–11% . The small number of patients in our study is therefore expected, even more so considering the relatively short observation period.…”

Section: Discussioncontrasting

confidence: 50%

“…Adaptation of machines and equipment designed for adult‐sized patients is often required. However, the provision of adequate vascular access remains the single greatest obstacle to successful hemodialysis in these patients .…”

mentioning

confidence: 99%

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Chronic Hemodialysis in Small Children

et al. 2016

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When peritoneal dialysis is inapplicable, chronic hemodialysis (HD) becomes the only available treatment option in small children. Due to small patient size, central venous catheters (CVC) are mainly used for vascular access. Over the past 4 years, four children weighing less than 15 kg received chronic HD in our unit. A total of 848 dialysis sessions were performed. Altogether, 21 catheters were inserted. In all but one occasion, uncuffed catheters were used. Catheter revision was performed 15 times during the study period, either due to infection or catheter malfunction. The median number of catheter revisions and the median line survival was 3.0/patient-year and 53 days (range; 6-373 days), respectively. There were 14 episodes of catheter related infections requiring 11 CVC revisions (78.6%). The median rate of line infections was 2.8/patient-year. Chronic HD in small children is demanding and labor intensive. Issues pertain mainly to CVCs and limit its long-term use.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionsupporting

confidence: 57%

Section: Discussioncontrasting

confidence: 50%

mentioning

confidence: 99%

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Chronic Hemodialysis in Small Children

et al. 2016

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“…Despite several advances in improving hemodialysis (HD), performing this specialized treatment modality still presents significant challenges in small children, especially in lower‐ and middle‐income countries (LMIC) . Factors, for example, vascular access, size of the extracorporeal circuit, and blood flow rate, need to be carefully considered.…”

mentioning

confidence: 99%

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

et al. 2018

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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.

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