Chronic hemodialysis in children weighing less than 10 kg

Abstract

This case series shows that chronic HD is a viable management option in children <10 kg. Access issues can be minimized with good line care to maximize line longevity and minimize line infection rates.

Chronic Hemodialysis in Small Children

“…Major technological progress over the past 20 years has made maintenance HD a viable treatment option for small children with ESRD, but still carries a significant morbidity and mortality risk . Problems pertaining to blood flow and extracorporeal blood volume in infants have to be considered since no more than 10% of their blood volume should be removed to prevent hypotension and anemia.…”

Hemodialysis in neonates and infants: A systematic review

“…Within the ten selected studies, a total of 248 infants were initiated and maintained on HD. 4,[8][9][10][11][12][13][14][15][16] The mean age of infants was 4.2 months (range: 3.2 days to 12 months) and recorded weight at the initiation of HD ranged from 0.7 kg to 11.8 kg. Treatment duration was quite variable (Table 1) ranging from 20 minutes to 4 hours a day, three to five times per week and with cumulative treatment duration of 3 hours to 24 months.…”

“…Twenty-five to 88% survived to receive kidney or liver (or both kidney and liver) transplantation. 8,9,12,13,16 Infants who exhibited evidence of neurodevelopmental delays ranged from 25% to 72%. 9,10,12 The overall survival rate was 23 of 40 for patients who had HD for acute indications while it was 158 of 208 for patients who had HD for chronic disorders.…”

“…While chronic use HD can be feasible with comprehensive services, it should be considered as a secondary alternative to PD. 13 3.1 | Ethical issues during dialysis of infants 28 The CARPEDIEM is also unique in its capability to allow combination extracorporeal therapies such as blood or plasma exchange and single-pass albumin dialysis with continuous veno-venous hemofiltration or continuous venovenous HD. Successful use of the CARPEDIEM has been reported in at least two newborn infants.…”

“…This is particularly true in the neonatal and infant period, when adjustment to (and by) the newborn is stressful; much more so in an infant with renal replacement needs. While chronic use HD can be feasible with comprehensive services, it should be considered as a secondary alternative to PD …”