SP890VENTRICULO-PERITONEAL SHUNTS IN CHILDREN ON HEMODIALYSIS: A SURVEY OF THE EUROPEAN PAEDIATRIC DIALYSIS WORKING GROUP (EPDWG)

Abstract

Introduction: Dialysis in children with concomitant ventriculo-peritoneal shunts (VPS) is rare. Registry data suggests that peritoneal dialysis (PD) is safe in children with VPS, but little is known on hemodialysis (HD) in children with VPS. Material(s) and Method(s): We performed a 10-year survey to determine the prevalence, risk factors and outcome for children with VPS on HD in 15 dialysis units participating in the European Pediatric Dialysis Working Group. Result(s): Eleven cases of HD with a VPS were reported in 15 pediatric units over the last 10 years (prevalence 1.33%; 321.8 patient months). HD or haemodiafiltration (HDF; n = 2) was the sole dialysismodality: no patient received peritoneal dialysis (PD) at any point and no patient switched to PD as a result of symptoms. One shunt was ventriculo-atrial. Median HD vintage was 2.4 years (inter-quartile range 1.70- 3.0). Median age at start of dialysis was 9.6 years (6-15.0). Vascular access consisted of central venous line (CVL) in 6 and arterio-venous fistula in 5 children. There were no reports of shunt infection or meningitis despite 3 CVL infections in 2 patients. Symptoms of hemodynamic instability were reported in 6 children (56%) at least once per week: hypotension or hypertension occurred in 36% (n=4) and nausea, vomiting and headaches in 18% (n=2), with less frequent hemodynamic instability in 4 others. Seizures on dialysis occurred less than once a month in 2 children (20%). One centre used prophylactic mannitol each session; and one commenced mannitol following advent of symptoms. On final follow-up at 4.0 years median (interquartile range 0.38-7.63), three patients remain on HD and eight have a functioning transplant. Conclusion(s): HD in children with a VPS is rare and is associated with frequent symptoms of hemodynamic instability, but no episodes of VPS infection or meningitis even in those with CVL sepsis.