1004 Rescue Treatment with Hemodiafiltration in Infants with End-Stage Renal Failure After Complications on Peritoneal Dialyses

Abstract

Objective: Mortality in infants with end-stage renal disease (ESRD) during early life is still high. The aim is the presentation of the efficacy of hemodiafiltration (HDF) in infants with ESRD and complications on peritoneal dialysis (PD). Patients and Methods: We show the alternative treatment with HDF in 4 infants requiring renal replacement therapy for ESRD before 28 days of life at a tertiary University Hospital from 1999 to 2010. Diagnoses leading to ESRD were cortical necrosis after perinatal shock, renal dysplasia in prune belly syndrome, neonatal Shigatoxinassociated hemolytic uremic syndrome, and bilateral nephrectomy in autosomal recessive polycystic kidney disease. Results and Discussion: Initially, 3/4 patients were started with HDF. Reasons were abdominal surgery in two patients and presumed acute renal failure in one patient. Thereafter all patients were switched to PD. If complications occurred on PD, patients were switched back to HDF. In case of severe volume overload we started with cHDF and continued with iHDF. During the first year of life, 3/4 patients required 1 to 3 HDF rescue treatment periods (major abdominal surgery in 5 periods, recurrent peritonitis in 1 period). 1/4 patients had to be switched to maintenance iHDF due to multiple abdominal leaks at 8 months of age. All 4 patients survived the first year of life. One patient is on maintenance PD at 23 months. Two patients were transplanted successfully at 22 and 35 months, respectively. In conclusion, in case of complications on PD, HDF is an option to achieve long-term survival and kidney transplantation.