Hemodialysis for end-stage renal disease in children weighing less than 10 kg

Abstract

Hemodialysis (HD) of infants with end-stage renal disease (ESRD) is technically difficult and labor intensive, although there are few data in the literature to document the outcomes of this treatment. We retrospectively reviewed all patients with ESRD who received HD between 1983 and 1997 who weighed <10 kg at the beginning of HD. A total of ten patients aged 2-27 months, weighing 3.5-9.5 kg, were identified. All patients were dialyzed through a central venous line; three had a failed sapheno-femoral loop and one a failed brachial shunt. Line clot was observed in nine and line sepsis in six patients. Subclavian vein stenosis was documented in one patient following removal of a clotted subclavian line. The mean urea reduction ratios calculated during the 1st and 3rd month of HD were only 54% and 49%, respectively. Anemia was a frequent problem, despite the use of erythropoietin in seven of the infants. Outcomes included: successful renal transplant in four, switch back to peritoneal dialysis in two, improved renal function and dialysis discontinuation in one, and death after withdrawal of treatment in three patients. All three patients who died were <5 months of age, weighed <5 kg, and were anuric; two of the three had congenital nephrotic syndrome. In conclusion, successful HD is possible in small children with ESRD, but morbidity is substantial and mortality is high.

Chronic Hemodialysis in Small Children

“…Poor line function due to malposition or thrombosis, followed by catheter infections is the most common cause of catheter failure . These complications are age related and are particularly common in infants and small children.…”

“…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 .…”

“…Sparse published data exist on maintenance HD treatment in low‐weight children, and the results are rather conflicting due to the high variability of outcome parameters. Catheter related infection and thrombosis of central venous lines represent the most common reported complications . In our retrospective study we sought to evaluate our experience with hemodialysis in this group of children focusing on the use, type and difficulties associated with CVCs when used for long‐term vascular access.…”