Hemodialysis in neonates and infants: A systematic review

Abstract

Hemodialysis (HD) in neonates and infants poses unique challenges due to high risks of mortality attributable to obligatory small blood flow volumes. Although HD is often necessary in neonates, its effectiveness and feasibility are poorly understood. The aim of this review is to describe in detail the few studies reporting on HD in neonates and infants (<12 months old) and then dissertate more broadly on the subject with an emphasis on recent innovations with potential to overcome traditional barriers for effective HD in this population. We detail the clinical characteristics, outcomes, technical considerations, maintenance and complications associated with HD, and provide guidance for addressing challenges associated with HD in this population.

Efficacy and safety of prolonged daily hemodialysis in critically ill children weighing less than 10 kg

“…6 The report by Sethi et al had 68 children with a median age of 9.3 years and a median weight of 31.2 kg. [8][9][10] Swadowski reported 216 HD sessions in 33 children less than 5 kg in weight, most of whom were neonates. 7 Conventional HD has been used successfully in small infants including neonates for renal disease, hyperammonemia, or AKI.…”

“…4,5 However, there are very few published reports on the safety and efficacy of other dialytic modalities in small infants and children. [6][7][8][9][10] Published reports on SLED in children are few. 6,7 The report by Lee et al had 14 children with a mean age of 14.9 AE 2.3 years and mean weight of 54.4 AE 23.3 kg.…”

“…7 Conventional HD has been used successfully in small infants including neonates for renal disease, hyperammonemia, or AKI. [8][9][10] Swadowski reported 216 HD sessions in 33 children less than 5 kg in weight, most of whom were neonates. Hypotension was seen in 64%, but 96% of the sessions were completed without premature termination.…”

Pediatric Hemodialysis

“…HD is preferred in certain conditions where a high rate of solute clearance is required such as tumor lysis syndrome, inborn error of metabolism, hyperkalemia, ingestion of dialyzable toxins, severe fluid overload, and severe lactic acidosis 5,6) . Hyper ammonemia is a common indication for acute HD in in fants with inborn error of metabolism, and the reported time from diagnosis to HD ranged from 2 to 19 hours 79) .…”

“…Hyper ammonemia is a common indication for acute HD in in fants with inborn error of metabolism, and the reported time from diagnosis to HD ranged from 2 to 19 hours 79) . Hemodialysis is an indication even in patients who are unable to perform PD due to recent abdominal surgery, abdominal drainage, and severe respiratory disease 5) .…”