Hemodialysis in children

Abstract

Chronic dialysis, including both hemodialysis and peritoneal dialysis, is technically feasible in children of all ages, including neonates [1]. In countries with active pediatric transplant programs, however, dialysis would not be the first choice of renal replacement therapy, as most pediatric nephrologists would aim for preemptive transplants in their patients. Despite that aim, across Europe half of patients start renal replacement therapy on peritoneal dialysis and one third on hemodialysis, and only the remainder are transplanted preemptively [2]. Some children will inevitably require a period on dialysis, such as the infant in whom dialysis may be necessary until adequate size for transplant is reached, the child needing urgent treatment because of presentation in end-stage kidney disease, and children needing native nephrectomies pre-transplant. Furthermore, only a minority of children are able to escape a period of dialysis either while waiting for their first transplant or because of subsequent graft failure. This means that overall, at any time, around 20 % of the pediatric end-stage kidney disease population is dialyzed [3, 4].