Chronic Hemodialysis in Small Children

Area of Science:

• Pediatric Nephrology
• Vascular Access Management
• Renal Replacement Therapy

Background:

• Peritoneal dialysis is not always feasible for pediatric patients requiring renal replacement therapy.
• Chronic hemodialysis (HD) becomes the primary treatment option when peritoneal dialysis is contraindicated.
• Central venous catheters (CVCs) are essential for vascular access in small children undergoing HD due to their size.

Purpose of the Study:

• To evaluate the outcomes and challenges associated with chronic hemodialysis (HD) in children weighing less than 15 kg.
• To analyze the performance and complications of central venous catheters (CVCs) used for vascular access in this pediatric cohort.
• To identify factors limiting the long-term use of HD in very small children.

Main Methods:

• Retrospective analysis of four pediatric patients (<15 kg) undergoing chronic HD over four years.
• Documented all central venous catheter (CVC) insertions, revisions, and reasons for removal.
• Calculated dialysis session numbers, catheter survival, revision rates, and infection episodes.

Main Results:

• A total of 848 dialysis sessions were performed using 21 CVCs, predominantly uncuffed.
• Catheter revisions occurred 15 times due to infection or malfunction, with a median line survival of 53 days.
• 14 catheter-related infections led to 11 CVC revisions, indicating a high infection rate (2.8/patient-year).

Conclusions:

• Chronic hemodialysis in small children is complex and resource-intensive.
• Central venous catheter complications, particularly infections and malfunctions, are major limitations for long-term HD therapy in this population.
• Further research is needed to improve vascular access strategies and optimize HD management for very young children.