ESPN 50th Annual Meeting

ESPN 2017


 
Hemodialysis in small children - data from the International Pediatric Hemodialysis Network
DAGMARA BORZYCH-DUZALKA Rukshana Shroff 2 Timo Jahnukainen 3 Dominik Mueller 4 Il Soo Ha 5 Gema Ariceta 6 Eva Simkova 7 Bruno Ranchin 8 Gunter Klaus 9 Constantinos Stefanidis 10 William Wong 11 Lale Sever 12 Marc Fila 13 Bradley Warady 14 Franz Schaefer 15 Claus P. Schmitt 15

1- DIVISION FOR PEDIATRICS, NEPHROLOGY AND HYPERTENSION, MEDICAL UNIVERSITY OF GDANSK, POLAND
2- Great Ormond Street Hospital, London, United Kingdom.
3- HUCH Hospital for Children and Adolescents, Helsinki, Finland
4- Charité, Virchow-Klinikum, Berlin, Germany
5- Kidney Center for Children and Adolescents, Seoul, Korea
6- Hospital Universitario Materno-Infantil Vall d Hebron
7- Dubai Hospital, Dubai, United Arab Emirates
8- Service de Néphrologie Pédiatrique, Hôpital Femme Mere Enfant, Lyon, France
9- Universitätsklinikum Giessen und Marburg GmbH, Marburg, Germany
10- A&P Kyriakou Childrens Hospital, Athens, Greece
11- Starship Childrens Hospital, Auckland, New Zealand
12- Cerrahpasa School of Medicine, Istanbul, Turkey
13- CHU Arnaud de Villeneuve, Montpellier, France
14- Childrens Mercy Hospital, Kansas City, USA
15- Division of Pediatric Nephrology, Centre for Pediatrics and Adolescent Medicine, Heidelberg University Medical Centre, Heidelberg, Germany
 
Introduction:

Hemodialysis in infants and toddlers is considered a reserve technique and has not been evaluated in detail.

Material and methods:

We compared treatment characteristics and outcomes of hemodialyzed children younger than 3 years with older children and adolescents dialyzed via CVL and prospectively followed by IPHN.

 

 

Results:

Among 395 patients, 46 (12%) started chronic HD before their 3rd birthday (median 1.5, range 0.1-2.9yrs). During 576 months a total of 87 CVL were placed in these infants, thereof 86%into the internal jugular vein.

Compared to children aged 3 years and older, younger patients had longer weekly dialysis duration (12.1±3.8 vs 11.4±2.8; p=0.02) and more frequent sessions (3.8±3.5 vs 3.0±2.9/week; p<0.001). Neither blood flow (157±62 vs 157±49 ml/min/m²), Kt/V (1.79±0.82 vs.1.65±0.59 per session), nor the prevalence of untoward HD effects differed from older patients (intradialytic hypotension 34 vs 27%, vomiting 12 vs 8%, seizures 1 vs 3% of sessions).

The interdialytic weight gain was lower (2.8±2.3% vs 3.7±3.5%; p<0.001) but systolic blood pressure higher in the infant group (2.48±1.6 vs 0.79±2.54 SDS, p<0.001), at a similar prevalence of anuria and no difference in LV mass index SDS. Hyperphosphatemia and hyperparathyroidism were less common in the infant group (p<0.0001). There were no differences in hemoglobin, transferrin saturation, malnutrition prevalence or serum albumin. EPO requirements were higher in younger children (415 vs 256 IU/kg/wk, p<0.0001). Hospitalization days (3 vs 15 per 100 days), catheter dysfunction and the rates of infection were significantly higher in the infants than in older children(2.7 vs 0.9 and 1.8 vs. 0.7 per 1000 catheter days; p<0.001).The mortality rate did not differ between the groups.

 

Conclusions:

HD is a safe and effective technology for infants, but associated with higher morbidity and access related complications.