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Acute hemodialysis of infants weighing less than five kilograms
R H Sadowski1, W E Harmon, K Jabs
1Division of Nephrology, Children's Hospital, Boston, Massachusetts.
Insights
Acute hemodialysis is a viable treatment for infants under 5 kg. Survival rates depend on the infant's underlying condition, not the hemodialysis procedure itself.
Area of Science:
- Pediatric Nephrology
- Neonatal Intensive Care
- Renal Replacement Therapy
Background:
- Infants weighing 5 kg or less often present complex medical challenges requiring specialized treatments.
- Acute hemodialysis has been used in neonates, but its efficacy and safety in very young infants are critical considerations.
Purpose of the Study:
- To review the outcomes of acute hemodialysis in infants weighing 5 kg or less.
- To determine the survival rates and factors influencing outcomes in this patient population.
Main Methods:
- Retrospective review of 33 infants weighing 5 kg or less treated with acute hemodialysis between 1980 and 1991.
- Analysis of indications for dialysis, access methods, treatment complications, and survival rates.
- Comparison of survival between different underlying medical conditions.
Main Results:
- Fifty-two percent (17 of 33) of infants survived hemodialysis.
- Survival rates varied significantly by indication: hyperammonemia (75%), primary renal disease (71%), and acute renal failure (33%).
- No significant differences in survival were observed based on birth weight, weight at initiation of hemodialysis, or number of treatments.
Conclusions:
- Acute hemodialysis is a successful treatment option for infants weighing less than 5 kg.
- Patient survival is primarily determined by the underlying medical condition, rather than complications of the hemodialysis procedure.
Abstract:
The records of 33 infants weighing 5 kg or less who received acute hemodialysis treatment at Children's Hospital between 1980 and 1991 were reviewed. Dialysis was initiated to treat hyperammonemia (8), primary renal or renovascular disease (7), and acute renal failure (18). The infants weighed 2.2 to 4.0 kg at birth and 27% were born prematurely. The infants were 2 to 120 days of age (median 10 days) and weighed 2.2 to 5.0 kg (median 3.5 kg) at the initiation of hemodialysis. Hemodialysis access was achieved via double-lumen 7 French catheters in 49% of the infants, the ECMO circuit in 24%, and the umbilical vessels in 27%. Thirty-three infants underwent a total of 216 hemodialysis treatments. Only nine treatments were discontinued prematurely: six for intractable hypotension and three for technical problems. Fifty-two percent (17 of 33) of the infants survived through the end of the hemodialysis treatment course. The survival rates for the infants with hyperammonemia (75%) and primary renal disease (71%) were better than those for infants with acute renal failure (33%). The survivors did not differ from those who died with respect to birthweight, weight when hemodialysis was initiated, or the number of hemodialysis treatments administered. We conclude that infants weighing less than 5 kg can be treated successfully with hemodialysis. Patient survival is related to underlying medical problems, not to complications of hemodialysis.