Hemodialysis In Children Research Articles

Late Complications of Long-term Hemodialysis in Children: Clinical Aspects and Some Measurable Variables Concerning Parathyroid Hormone, Divalent Ions, Acid-base Metabolism, Anemia, Nutrition, Growth and Survival Data

Nineteen pediatric patients, ranging in age from 5 to 17 years, were followed for up to 59 months and 3,129 hemodialysis procedures were done. The known duration of renal diseases before hemodialysis was 6 ± 3 years. The clinical complications consisted of 5 patients with sepsis, 2 patients with malignant hypertension, 6 patients with congestive heart failure, 3 patients with seizure disorders and 1 patient with intractable ascites. Radiologic evidence for renal osteodystrophy was present in 4 patients, although elevated levels of parathyroid hormone were documented in all patients after 6 months of hemodialysis.Hypocalcemia (8.4 ± 1.7mg./dl.) was documented before initiation of hemodialysis and normalization occurred in only half of the patients after 6 months of hemodialysis with the dialysate calcium concentration of 3mEq./l. Pre-dialysis serum concentrations for magnesium (2.5 ± 0.4mg./dl.), phosphorus (5.3 ± 1.5mg./dl.), triglyceride (138 ± 31mg./dl.), cholesterol (180 ± 34mg./dl.) and total protein (6.6 ± 0.6gm./dl.) were normal. Elevated values were found for hydroxyproline (19.6 ± 2.9 μg./dl.) and uric acid (9.3 ± 1.5mg./dl.).Metabolic acidosis (total carbon dioxide <20mEq./l.) was present in 50 per cent of the patients and corrected only in half of these after hemodialysis. The mean hematocrit concentration was 13.8 ± 2.0 per cent. A 50 per cent reduction in serum creatinine (10 ± 2 to 5 ± 2mg./dl.) and urea (101 ± 29 to 50 ± 27mg./dl.) was achieved after 4 to 5 hours of hemodialysis. The dietary intakes of 1,000 ± 400 calories per m.2 per day and 1.3 ± 1gm./kg. per day of protein were 50 and 90 per cent that of recommended allowances. Height measurements under the third percentile of normal were noted in 62 per cent of the children. The actuarial survival data showed a mean survival at 2 years of 75 per cent.

Chronic hemodialysis in children

Chronic hemodialysis in children

Technical aspects and results of regular hemodialysis in children.

Technical aspects and results of regular hemodialysis in children.

Hemodialysis in children. Experience with arteriovenous shunts.

Since 1967, a total of 64 patients have been treated at the Childrens Hospital of Los Angeles by hemodialysis for renal failure. The use of carefully sized intraluminal Scribner shunt tubes, Thomas shunts with end-to-side anastomoses, and subcutaneous vein graft arteriovenous (AV) fistulas all have decreased the need for surgical revision. In those patients requiring revisions, even multiple ligations of a major artery of one extremity have not produced distal vascular insufficiency. A practical approach to the selection of the shunt site and type is the use of a Scribner shunt in the forearm of a child 10 years of age or older if the length of dialysis period will not be longer than eight weeks. When a long-term dialysis is expected, a saphenous vein graft AV fistula below the elbow is preferred. In the smaller children a Scribner shunt in the arm with use of a brachial artery or a Thomas shunt in a lower extremity are preferred.

A new type subcutaneous arteriovenous fistula for chronic hemodialysis in children : J. J. Perez Alvarez, R. Vargas-Rasendo, R. Gutierrez-Basque, M. Motas Diaz-Ordoz and D. Santas-Atherton. Surgery 67:355–359 (February), 1970

A new type subcutaneous arteriovenous fistula for chronic hemodialysis in children : J. J. Perez Alvarez, R. Vargas-Rasendo, R. Gutierrez-Basque, M. Motas Diaz-Ordoz and D. Santas-Atherton. Surgery 67:355–359 (February), 1970

Hemodialysis in children.

Twenty-five children, aged 1 to 17 years, with end-stage renal disease were hemodialyzed intermittently for periods of 1 to 22 months in preparation for renal homotransplantation. The clinical manifestations of uremia were adequately controlled. Minimal difficulties were encountered with the silicone rubber-polytef (Teflon) arteriovenous cannula. Complications related to extended hemodialysis were not excessive. No major personality problems, family difficulties, or breakdowns were observed to develop in the context of the treatment program.

Synthetic arteriovenous shunts for hemodialysis in children

Venography is invaluable in the placement of synthetic arteriovenous shunts for hemodialysis. The forearm veins of uremic children are anatomically variable and may be hidden from view in edematous tissues and obstructed by scattered thrombi resulting from repeated vein punctures. Venography is used to select the vein which will most effectively carry blood away from the shunt, thus facilitating placement of the cannulae and increasing the length of time they can be expected to function.

Hemodialysis in infants under 1 year of age for acute poisoning.

SINCE hemodialysis was first used for the therapy of poisoning, 1 many adults have been treated successfully. 2 Although acute poisoning with various toxins commonly occurs in children, we have been able to find only 27 (Table 1) reported cases of hemodialysis for acute poisoning in this age group. Of these 27 children, only one was under 1 year of age. This report describes our experience with hemodialysis, using a small Kiil dialyzer after cannulation of the superficial femoral artery and saphenous vein, in two infants (ages 7 and 10 months) with acute poisoning. In addition, the literature on hemodialysis in children for poisonings and hemodialysis in infants under 1 year of age is reviewed. Methods Cannulation. —The teflon-silastic cannula described by Quinton et al 10 were used. Under light general anesthesia, the superficial femoral artery and saphenous vein were isolated in the femoral triangle and cannulated with No. 16

Extended hemodialysis in children with chronic renal failure

Five adolescents from 12 to 15 years of age with end-stage renal disease weredialyzed intermittently for periods of 1 to 6 months, using a low-resistance, pumpless, no-prime dialyzer (single layer of a standard two-layer Kiil). Minimal difficulties were observed with the silastic-teflon arteriovenous cannula. A relatively unrestricted diet was permitted with limitation of fluids to 1 L. and no added salt. Hypertension responded to removal of fluid by ultrafiltration. In adolescents weighing 28 to 52 kilograms, extended hemodialysis 2 to 3 times weekly for periods of 16 to 21 hours was found to be simple, without serious complications, and adequate to control the symptoms of uremia. This method of intermittent hemodialysis is recommended for children in preparation for live or cadaveric renal homotransplantation.

Hemodialysis in children: Report of five cases

Eight hemodialyses were performed in five patients whose ages ranged from 2 to 14 years. Four patients survived; one patient improved temporarily and then died. The etiologic factors that lead to renal failure were transfusion accident in one patient, shock secondary to meningococcal septicemia in one, chronic glomerulonephritis with necrotizing arteriolitis in one (the patient who died), and what appearted to be acute glomerulonephritis in two patients. Eight hemodialyses were performed in five patients whose ages ranged from 2 to 14 years. Four patients survived; one patient improved temporarily and then died. The etiologic factors that lead to renal failure were transfusion accident in one patient, shock secondary to meningococcal septicemia in one, chronic glomerulonephritis with necrotizing arteriolitis in one (the patient who died), and what appearted to be acute glomerulonephritis in two patients.