Chronic Hemodialysis in Small Children

Novljan, Gregor; Rus, Rina; Premru, Vladimir; Ponikvar, Rafael; Battelino, Nina

doi:10.1111/1744-9987.12441

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…Catheter‐related infection rates in similar studies from well‐resourced countries are reportedly between 1.2 and 4/1000 catheter days . In our cohort, this was 1.1/1000 catheter days, which is quite remarkable in a less‐resourced environment.…”

Section: Discussionsupporting

confidence: 59%

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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Section: Discussionsupporting

confidence: 59%

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

et al. 2018

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“…We are currently using 4% citrate for catheter locking at our pediatric dialysis unit, with periodic use of tissue plasminogen activator (t-PA) once weekly, which has been advocated to reduce catheter malfunction as well as CRBSI in adult hemodialysis patients. 15 In small children weighing less than 15 kg, catheter-lock is performed exclusively with t-PA. 4 In contrast, a 30% citrate solution has been used in adult hemodialysis patients at our center since 2005, with excellent infection and catheter malfunction rates.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Thrombosis and infection are the major complications of indwelling dialysis catheters and are particularly common in small children. 3,4 After each hemodialysis session, a locking agent is instilled into the catheter to prevent clotting between treatments, and may even prevent catheterrelated bloodstream infections (CRBSI). Trisodium citrate is now widely replacing heparin for catheter locking and can be potentially superior to heparin in terms of antithrombotic and antimicrobial properties.…”

Section: Introductionmentioning

confidence: 99%

Citrate-induced local ionized calcium decrease in pediatric hemodialysis settings: An in-vitro study

et al. 2021

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Background: Citrate is instilled into the dialysis catheter to prevent clotting and to maintain patency between dialysis sessions. A significant amount of citrate leaks from the catheter at the injection time, which decreases the blood ionized calcium concentration (Ca2+) due to chelation. We aimed to evaluate the local impact of concentrated (i.e. 30%) citrate spilling on Ca2+ at the catheter tip in real-time pediatric conditions. Methods: An in-vitro model was constructed, involving an ion-selective electrode (Ca-ISE). A pre-curved catheter and the Ca-ISE were submerged in a glass vessel with the tips positioned adjacent to each other. The vessel was filled with 30 and 80 ml of normal saline with added calcium to simulate normal right atrium size in children and adults, respectively, and normal blood Ca2+. The amount of instilled citrate matched the filling volume of the catheter. Measurements were performed with 4% and 30% citrate solutions. Results: The mean Ca2+ measured at the tip of the catheter was 0.457 and 0.058 mmol/l when using 4% and 30% citrate, respectively ( p < 0.001). The mean Ca2+ recorded in 30 and 80 ml after instilling 30 % citrate was 0.058 and 0.055 mmol/l, respectively ( p = 0.878). Conclusions: The spilling of 30% citrate caused a strikingly greater decrease of Ca2+ at the catheter tip than the standard 4% citrate. The atrial volume did not influence the test results implying similar safety concerns for pediatric and adult patients. The used static experimental setting might have overestimated the spilling effect.

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“…Single center data have revealed that greater than 90% of infants receiving chronic HD are accessed via a right or left internal jugular central venous catheter (CVC) 5-8 French in diameter with a median 2.2 catheter changes/patient year and catheter survival times ranging from 1 to 13 months [48,[51][52][53]. Catheters are generally locked with heparin, citrate based solutions, and/or alteplase solutions, based on data from various single center studies with no specific reference to the experience in infants [50,54].…”

Section: Hemodialysismentioning

confidence: 99%

End-stage kidney disease in infancy: an educational review

Sanderson

Warady

2018

Pediatr Nephrol

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An increasing number of infants with end-stage kidney disease (ESKD) are surviving and receiving renal replacement therapy (RRT). Unique clinical issues specific to this age group of patients influence their short-and long-term outcomes. This review summarizes current epidemiology, clinical characteristics, ethical dilemmas, management concerns, and outcomes of infants requiring chronic dialysis therapy.Optimal care during infancy requires a multidisciplinary team working closely with the patient's family. Nutritional management, infection prevention and attention to cardiovascular status are important treatment targets. Although mortality rates remain higher among infants on dialysis compared to older pediatric dialysis patients, outcomes have improved over time. Most importantly, infants who subsequently receive a kidney transplant are now experiencing graft survival rates that are comparable to older pediatric patients.

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Chronic Hemodialysis in Small Children

Cited by 6 publications

References 23 publications

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

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

Citrate-induced local ionized calcium decrease in pediatric hemodialysis settings: An in-vitro study

End-stage kidney disease in infancy: an educational review

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