Chronic haemodialysis in infants and children less than 15 kg

Area of Science:

• Pediatric Nephrology
• Renal Replacement Therapy
• Chronic Kidney Disease Management

Background:

• Peritoneal dialysis (PD) is standard for pediatric CKD stage 5, but chronic haemodialysis (cHD) is an alternative.
• cHD in children presents unique challenges requiring specialized expertise.
• This study focuses on cHD in low-weight children (<15 kg).

Purpose of the Study:

• To describe the clinical history, complications, and outcomes of pediatric patients (<15 kg) undergoing chronic haemodialysis (cHD).
• To evaluate the feasibility and challenges of cHD in infants and young children with end-stage renal disease.
• To provide insights for clinicians managing this specific patient population.

Main Methods:

• Retrospective descriptive study of clinical records for patients <15 kg on cHD for >3 months.
• Data collected included reasons for CKD stage 5, age, treatment duration, anthropometric and metabolic variables.
• Vascular access, complications, and clinical outcomes were meticulously recorded.

Main Results:

• Fifteen patients (median age 30 months, median weight 11.2 kg) were analyzed.
• Median cHD duration was 15 months, with 45 tunneled catheters used (median survival 106 days).
• Vascular access loss (39%) and infection rate (0.76/1000 catheter days) were noted; 10 patients received transplants.

Conclusions:

• Chronic haemodialysis (cHD) is a feasible treatment option for children weighing less than 15 kg.
• Addressing specific clinical and technical challenges is crucial for successful pediatric cHD.
• This approach offers a viable alternative for kidney replacement therapy in young children when PD is not possible.