LONG TERM HAEMDDIALYSIS IN LOW-WEIGHT CHILDREN

Abstract

Since 1969 to 1.2.1980, we accepted 10 children weighing 6 to 10 kg (aged 1 1/2 to 3 years), for an haemodialysis program. Renal hypoplasia with urinary tract abnormalities was the most common cause (6/10). Initial blood access was an arteriovenous shunt inserted on brachial vessels in the 2 firstcases (1969-1970) then an arteriovenous (A/V) fistula in all other patients afterwards: direct A/V fistula on brachial artery (6 cases) or radial artery (one 9-kg-boy), and teflon graft on brachial artery (one 8-kgchild). During the course of treatment, 9 children had 12 fistulas (mean survival of these fistulas 11 months, range 1 to 32 months). A single needle system was routinely used in only one case. Different multilayers dialysers (0,24 to 0,54 m2) were used for a total of 6 to 16 hours a week, in 2 or 3 sessions, according to weight, and dialysers' performances. Dialyses were generally well tolerated in children over 7 kg but needed permanent monitoring of weight in 6,kg children. Complications, except thrombosis of blood access (2/2 shunts, 5/12 fistulas) were uncommon. No cardiac failure was observed. One child died from anaphylactic shock; 2 were successfully transplanted after 18 and 30 months of haemodialysis, and 8 are still haemodialyzed for respectively: 2, 10, 10, 16, 19, 32 months and 10 1/2 years. Children's psychological acceptance was good and their mental development seemed normal. Height gain during dialysis treatment was variable but always present. Long term haemodialysis is thus possible even in very small children.