Chronic hemodialysis in children weighing less than 10 kg

Abstract

Hemodialysis (HD) in infants is usually used when peritoneal dialysis (PD) has failed. We describe our experience with HD, outlining the morbidity, complications, and outcomes for infants weighing less than 10kg managed with HD for more than 6months over a 10-year period. A retrospective review of the clinical notes was conducted to collect demographic information, anthropometric data, dietary history, site and form of vascular access, details of HD prescription, complications, and outcomes. Nine patients weighing less than 10kg were hemodialyzed for more than 6months. Median age at commencement was 9months. Median weight and height standard deviation score (SDS) at commencement of HD were -2.14 and -0.61, respectively, and at the end they were -1.56 and -1.61. Median energy intake was 96.6kcal/kg/day and protein intake was 1.66g/kg/day. Median number of line revisions was 0.32 line changes/patient year. Median central venous catheter (CVC) longevity was 13months. Mean rate of line infection was 0.14/patient year. Median time on HD was 27months. Median age at transplantation was 3.4years. This case series shows that chronic HD is a viable management option in children <10kg. Access issues can be minimized with good line care to maximize line longevity and minimize line infection rates.