The challenges of maintaining dialysis lines in the under TWOS

Abstract

Purpose Haemodialysis (HD) and peritoneal dialysis (PD) are essential adjuncts in management of children with chronic kidney disease (CKD). We reviewed catheter life and complications in children younger than 2 years undergoing chronic HD and PD at our tertiary centre. Material and Methods 28 children with CKD born between 1990 and 2008 retrieved from our database were commenced on dialysis before the age of 2. Adequate data for analysis was available in 22. Results 90 lines were inserted (40 PD and 50 HD) in 22 children. The median number of lines per patient was 3.5. 11 children were under the age of 6 months at initial dialysis; 6 of these were under the age of 1 month,the youngest being 5 days old. PD (the procedure of choice) was offered to all but two children who were maintained solely on HD due to specific reasons (anticipated liver transplant, multiple abdominal stomas). 4 children were managed with PD alone but the remainder had both HD and PD. Complications necessitating removal of the dialysis catheter were as follows: (PD catheters:40) Infection 18 (45) Blockage 3 (7.5) Infection+Block 4 (10) Migration of tip 2 (5) Reason unknown 1 (2.5). 7 PD were electively removed at end of therapy. 4 are currently in use. The complications for HD catheters (50) were Infection 18 (36) Block 7 (14) Cuff extrusion 5 (10) Line split/leak 3 (6) Unknown 1 (2). 4 HD were removed electively at the end of therapy. 3 HD are currently in use. 1 child died of overwhelming sepsis secondary to PD peritonitis. Average life for HD was 3 months and PD 9.1 months. Conclusions Children younger than 2 years can be dialysed successfully by HD or PD but complications are frequent, leading to >2 catheters in the majority of patients in our series. When embarking on chronic dialysis in the very young, the likelihood of complications and revision surgery needs to be explained. Haemodialysis (HD) and peritoneal dialysis (PD) are essential adjuncts in management of children with chronic kidney disease (CKD). We reviewed catheter life and complications in children younger than 2 years undergoing chronic HD and PD at our tertiary centre. 28 children with CKD born between 1990 and 2008 retrieved from our database were commenced on dialysis before the age of 2. Adequate data for analysis was available in 22. 90 lines were inserted (40 PD and 50 HD) in 22 children. The median number of lines per patient was 3.5. 11 children were under the age of 6 months at initial dialysis; 6 of these were under the age of 1 month,the youngest being 5 days old. PD (the procedure of choice) was offered to all but two children who were maintained solely on HD due to specific reasons (anticipated liver transplant, multiple abdominal stomas). 4 children were managed with PD alone but the remainder had both HD and PD. Complications necessitating removal of the dialysis catheter were as follows: (PD catheters:40) Infection 18 (45) Blockage 3 (7.5) Infection+Block 4 (10) Migration of tip 2 (5) Reason unknown 1 (2.5). 7 PD were electively removed at end of therapy. 4 are currently in use. The complications for HD catheters (50) were Infection 18 (36) Block 7 (14) Cuff extrusion 5 (10) Line split/leak 3 (6) Unknown 1 (2). 4 HD were removed electively at the end of therapy. 3 HD are currently in use. 1 child died of overwhelming sepsis secondary to PD peritonitis. Average life for HD was 3 months and PD 9.1 months. Children younger than 2 years can be dialysed successfully by HD or PD but complications are frequent, leading to >2 catheters in the majority of patients in our series. When embarking on chronic dialysis in the very young, the likelihood of complications and revision surgery needs to be explained.