The outcome of chronic dialysis in infants and toddlers - Advantages and drawbacks of haemodialysis

Abstract

Background. Improvements in dialysis technology allow replacement therapy for even the youngest of children with end stage renal disease. Nevertheless, the cumulative experience in this age group is limited. Methods. We compared the outcome of 20 children who initiated chronic dialysis before the age of 1 year (weight 4.9 ± 2 kg, Group 1), with a particular focus on those under the age of 1 month (eight children, weight 2.9 ± 0.34), to that of 14 patients, aged 1.1-3 years when starting dialysis (weight 10.1 ± 1.7, Group 2). Results. The outcome was poor in the youngest age group; only 3/8 survived to 3 years. Of those who started dialysis between the ages of 0.3 and 3 years, 84% underwent kidney transplantation. The survival of 1-, 3-, 5- and 8-year-old patients was 96%, 88%, 84% and 84% respectively. Severe co-morbidities were present in almost half of those who died. Hospital stay was 3.5 times longer in Group 1 than in Group 2 during the first 3 months of dialysis. Permanent central venous catheters inserted under ultrasound guidance resulted in a 4.4-fold increase in catheter survival compared to non-cuffed catheters. Marked blood loss at beginning of haemodialysis (HD) is attributable to residual volume in the dialysis system (15.7 mL/kg/month) and frequent blood tests (12.1 ± 5.9 mL/kg/month). These values decreased 2-fold after 8 months of treatment. Conclusions. The main factors determining the poor outcome of infants on dialysis are extremely young age at initiation and severe co-morbidities. Despite some disadvantages, HD may be successfully implemented in infants and toddlers, in highly specialized centres with a well-trained nursing staff. © The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.