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Renal replacement therapy in infants with chronic renal failure in the first year of life
Mirja Wedekin1, Jochen H H Ehrich, Gisela Offner
1Department of Pediatric Nephrology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625 Hannover, Germany.
Insights
Renal replacement therapy (RRT) in infants offers excellent survival chances. This study shows long-term outcomes for infants undergoing RRT are comparable to older children.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Data on renal replacement therapy (RRT) in neonates is limited.
- Recent improvements in RRT for children contrast with scarce data for infants.
Purpose of the Study:
- To analyze the outcomes of RRT in infants under one year of age.
- To evaluate survival rates and long-term results of dialysis and transplantation in this population.
Main Methods:
- Retrospective analysis of 29 infants (<1 year) with end-stage renal failure undergoing RRT (1997-2008).
- Data collected on dialysis (peritoneal dialysis) and transplantation (RTx) outcomes, including survival and comorbidities.
Main Results:
- 27 infants received peritoneal dialysis; 2 received preemptive RTx.
- 21 of 29 infants survived with RTx; 5-year patient and graft survival after RTx was 95.5%.
- Main causes of death were cardiovascular and cerebral comorbidities; 6 infants died.
Conclusions:
- RRT in infants <1 year provides excellent survival chances.
- RRT should be considered for all infants without severe extrarenal comorbidities.
- Long-term outcomes for infants undergoing RRT may be comparable to older children.
Background And Objectives:
Although results of renal replacement therapy (RRT) in small children have improved during recent years, data about RRT in neonates are scarce.
Design, Setting, Participants, & Measurements:
In a retrospective study, we analyzed the outcome of infants who had chronic kidney disease and started RRT within their first year of life. Between 1997 and 2008, all 29 infants who were younger than 1 yr, had end-stage renal failure, and underwent RRT (dialysis or transplantation) at Hannover Medical School were analyzed for up to 12 yr.
Results:
Twenty-seven of 29 infants with chronic kidney disease received peritoneal dialysis, starting at a mean age of 112 d; two children received preemptive renal transplantation (RTx). During follow-up, 21 of 29 children survived with RTx. The 5-yr patient and graft survival rate after RTx was 95.5%. Six of 29 children died, one with a functioning graft and five while on peritoneal dialysis. The main causes of death were severe cardiovascular and cerebral comorbidities. The mean GFR at last follow-up of patients who underwent RTx (mean time after RTx 5.1 yr) was 63.2 ml/min per 1.73 m(2).
Conclusions:
RRT in infants who are younger than 1 year offers excellent chances of survival and should be offered to all infants who do not have severe, life-limiting extrarenal comorbidity. Contrary to previous observations, the long-term outcome of infants may be comparable to that of older children who undergo RRT.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...