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Dialysis therapy in children
1Nephrology Division, Bai Jerbai Wadia Hospital for Children, Jaslok Hospital and Research Center and Bombay Institute for Prevention and Control of Kidney Diseases, Mumbai.
Insights
Pediatric dialysis, including hemodialysis and peritoneal dialysis, offers life-saving and life-sustaining treatments for children with kidney failure and metabolic disorders. Peritoneal dialysis is recommended for younger children due to technical challenges with hemodialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Critical Care Pediatrics
Background:
- Acute dialysis is crucial for pediatric emergencies like acute renal failure, poisoning, and metabolic disorders.
- Chronic dialysis supports children with end-stage renal disease awaiting transplantation.
- Dialysis principles in children mirror adult practices, applicable from newborns to adolescents.
Purpose of the Study:
- To outline the principles, indications, procedures, and challenges of acute and chronic dialysis in pediatric patients.
- To compare the suitability of hemodialysis and peritoneal dialysis in different pediatric age groups.
- To highlight the requirements for establishing a successful pediatric dialysis program.
Main Methods:
- Review of established pediatric dialysis protocols and equipment.
- Comparison of technical feasibility and outcomes between hemodialysis and peritoneal dialysis in infants and young children.
- Discussion of the multidisciplinary team approach for pediatric end-stage renal disease management.
Main Results:
- Hemodialysis presents technical and hemodynamic challenges in children aged 0-5 years.
- Peritoneal dialysis is a simpler, efficient, and safer alternative for infants and young children.
- Availability of pediatric-specific dialysis equipment is improving, but cost remains a barrier for chronic peritoneal dialysis in India.
- A specialized multidisciplinary team is essential for effective pediatric dialysis programs.
Conclusions:
- Acute peritoneal dialysis should be accessible in all pediatric emergency departments.
- Peritoneal dialysis is a viable and recommended option for pediatric dialysis, especially in younger children.
- Addressing cost and ensuring specialized team availability are key to expanding pediatric dialysis services.
Abstract:
Acute dialysis can be life saving for children suffering from acute emergencies due to acute renal failure, poisoning or inborn errors of metabolism causing severe organic acidaemia and hyperammonaemia. Chronic dialysis is life sustaining for children with chronic renal failure or end stage renal disease till renal transplantation is performed. The basic principles, indications, procedures, equipment, complications of acute and chronic dialysis in children are same as in adults. Dialysis can be performed in children at any age from newborn to adolescent period. In newborn, infants and preschool children (0-5 years age) haemodialysis is difficult due to technical problems associated with vascular access and haemodynamic instability. Peritoneal dialysis is simple, efficient, easy to perform, does not require highly sophisticated equipment or personnel and with low complication rate. For successful dialysis appropriate sizes of catheters, tubings, dialysers, small volume dialysate bags, etc, are required. These are now available in our country, although the cost of peritoneal dialysis fluid and catheters, etc, is 2-3 times higher than equipment for haemodialysis. Hence, continuous ambulatory peritoneal dialysis for chronic renal failure/end stage renal disease has not taken off yet in India. A team of experts including specially trained paediatric nephrologists, urologists, nurses, dieticians, technicians and social workers are needed to organise dialysis programme for children with end stage renal disease. Acute peritoneal dialysis should be made available in each paediatric department offering emergency services to children.