Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry.

Abstract

Chronic haemodialysis (HD) in small children has not been adequately investigated. This was a retrospective investigation of the use of chronic HD in 21 children aged <2years (n = 12 aged <1 year) who were registered in the Italian Pediatric Dialysis Registry. Data collected over a period of >10years were analysed. The median age of the 21 children at start of HD was 11.4 [interquartile range (IQR) 6.2-14.6] months, and HD consisted mainly of haemodiafiltration for 3-4h in ≥4 sessions/week. A total of 51 central venous catheters were placed, and the median survival of tunnelled and temporary lines was 349 and 31days, respectively (p < 0.001). Eight children (38%) showed evidence of central vein thrombosis. Although 19% of patients received growth hormone and 63.6% received enteral feeding, the weight and height of these patients remained suboptimal. During the HD period the haemoglobin level increased in all patients, but not to normal levels (from 8.5 to 9.6g/dl) despite erythropoietin administration (503-600 U/kg/week). The hospitalisation rate was 1.94/patient-year. Seventeen patients underwent renal transplantation at a median age of 3.0years. Four patients, all affected by severe comorbidities, died during follow-up (in 2 cases due to absence of a vascular access). The 5- and 10-year cumulative survival was 82.4 and 68.7%, respectively. Extracorporeal dialysis is feasible in children aged <2years, but comorbidities, vascular access, growth and anaemia remain major concerns.