SAT-232 HEMODIALYSIS IN CHILDREN AND ADOLESCENTS: A SYSTEMATIC REVIEW

Abstract

Hemodialysis (HD) in children is often utilized in situations such as acute or chronic kidney disease, severe electrolyte imbalance, toxicities, and hyperammonemia. Proper HD in children require careful manipulation of technical parameters including blood and dialysate flow rate, type/size of dialyzer and dialysate composition. Although general principles of hemodialysis are similar between adults and children, there are several unique aspects of HD inherent to the pediatric population. Issues of hemodynamic stability, obtaining ideal vascular access and preventing complications from HD can prove challenging in this patient population. In this systematic review, we evaluate the existing literature regarding the use of hemodialysis in children and young adults (ages 1-20 years). Furthermore, we summarize this data to compile guidelines for best practice. A systematic search of all relevant studies and abstracts was conducted using several electronic databasesby utilizing appropriate key words by an expert hospital librarian. Eligible studies included children aged 1-20 years with acute or chronic indications for hemodialysis. Studies prior to Jan 1990 or on continuous renal replacement therapy, peritoneal dialysis, modified forms of hemodialysis (nocturnal, hemodiafiltration, etc.) were excluded. In addition, studies that were non-English or involved < 5 patients were excluded. Titles and abstracts were screened by two independent reviewers, followed by a full text review of included articles. Data on HD indications, specific parameters of the HD protocol, including dialysate composition, dialysate flow, blood flow, urea reduction rate and ultrafiltration goals were collected. We also collected data regarding medications, anticoagulation and blood transfusions required along with outcomes such as mortality and kidney transplantation. Preliminary results of this systematic search returned a total number of 16,196 papers. After screening for relevant titles and abstracts, and exclusion based on criteria defined above, a total of 102 papers remained. Further assessment of full text of articles led to inclusion of 55 papers in this review. Results showed that congenital abnormalities, glomerulopathy and obstructive uropathy were some of the most common indications of HD. The mean age of HD was 12.7 ±2.9 years. Mean dialysis session duration was 223.7 ±65.6 min/session, with 3.2 ±0.6 sessions/week. Mean dialysate flow was 480±46.8 ml/min and mean blood flow was 192.5±65.5 ml/min. A subset of studies (n=5) reported mean blood flow relative to body weight as 4.7±0.5 ml/kg/min. Mean urea reduction ratio was 44.9±30.0%. Most common types of vascular access were central venous catheters and arteriovenous fistulas. The most common complications were access-related infection and thrombosis. From studies with reported outcomes, 7.68% of children died and 42% were transplanted. The use of HD in children presents unique challenges due to age-related differences in physiology, risk of complications and increased emphasis on long-term health. This systematic review summarizes the available literature on HD, in terms of indication, technical aspects and outcomes. Ultimately, this data can help to guide safe, effective HD treatment in children and in formulating guidelines for best practice.