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Evolution and change in paradigm of hemodialysis in children: a systematic review
Rahul Chanchlani1,2, Claire Young3, Aisha Farooq3
1Department of Pediatrics, McMaster Children's Hospital, Hamilton, Ontario, Canada.
Insights
This systematic review highlights pediatric hemodialysis (HD) practices, showing common indications like congenital abnormalities and glomerulopathy. Outcomes improve with age, with lower mortality and higher transplantation rates in older children receiving HD.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Hemodialysis (HD) in children shares similarities with adult practices but has unique pediatric considerations.
- Understanding these pediatric specifics is crucial for optimizing treatment.
Purpose of the Study:
- To systematically review and analyze existing literature on hemodialysis in children and young adults (1-20 years).
- To evaluate vascular access, indications, parameters, and outcomes of pediatric HD.
- To reflect on the evolution of HD practices in this population over three decades.
Main Methods:
- Systematic literature search across major databases (Medline, Embase, CINAHL, Web of Science, Cochrane Library).
- Inclusion of studies on HD in children aged 1-20 years.
- Independent review and data extraction by two reviewers focusing on indications, vascular access, outcomes, and HD parameters.
Main Results:
- Fifty-four studies involving 8751 patients were analyzed, stratified by age groups (1-5, 6-12, 13-20 years) and publication era.
- Arteriovenous fistulas and central venous catheters were common vascular access methods.
- Congenital abnormalities and glomerulopathy were leading indications for HD.
- Mortality rates decreased with age (23.3% in 1-5 yrs to 2.0% in 13-20 yrs), while transplantation rates varied (41.6% in 1-5 yrs to 21% in 13-20 yrs).
Conclusions:
- This review provides a comprehensive summary of pediatric HD literature, covering vascular access, indications, technical aspects, and outcomes.
- Findings reflect trends and practices in pediatric hemodialysis over the past 30 years.
- The data underscores the importance of tailored approaches to hemodialysis in different pediatric age groups.
Background:
There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD literature, including vascular access, indications, parameters, and outcomes as a reflection on real-life HD practices.
Methods:
Medline, Embase, CINAHL, Web of Science, and Cochrane Library were systematically searched for literature on HD in children (1-20 years). Two reviewers independently assessed the literature and data on indications; vascular access, outcomes, and specific parameters for HD were extracted.
Results:
Fifty-four studies (8751 patients) were included in this review. Studies were stratified into age groups 1-5, 6-12, and 13-20 years based on median/mean age reported in the study, as well as era of publication (1990-2000, 2001-2010, and 2011-2019). Across all age groups, both arteriovenous fistulas and central venous catheters were utilized for vascular access. Congenital abnormalities and glomerulopathy were the most common HD indications. HD parameters including HD session duration, dialysate and blood flow rates, urea reduction ratio, and ultrafiltration were characterized for each age group, as well as common complications including catheter dysfunction and intradialytic hypotension. Median mortality rates were 23.3% (3.3), 7.6% (14.5), and 2.0% (3.0) in ages 1-5, 6-12, and 13-20 years, respectively. Median transplantation rates were 41.6% (38.3), 52.0% (32.0), and 21% (25.6) in ages 1-5, 6-12, and 13-20, respectively.
Conclusion:
This comprehensive systematic review summarizes available literature on HD in children and young adults, including best vascular access, indications, technical aspects, and outcomes, and reflects on HD practices over the last three decades.
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