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[Chronic hemodialysis in children]
A Delucchi1, E Gutiérrez, L García de Cortázar
1Servicio de Pediatría, Hospital Gustavo Fricke, Santiago, Chile.
Insights
Pediatric hemodialysis in Chile shows that renal transplantation is the ultimate goal for children with end-stage renal disease. Improvements in vascular access and pediatric-specific equipment can reduce complications and mortality.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Transplantation Medicine
Context:
- Pediatric end-stage renal disease (ESRD) management often involves long-term hemodialysis.
- Renal transplantation is the definitive treatment goal for children with ESRD.
- Chilean pediatric hospitals serve as reference centers for renal transplantation.
Purpose:
- To document the experience of pediatric hemodialysis in two major Chilean pediatric hospitals.
- To analyze patient demographics, etiologies of ESRD, treatment duration, and outcomes.
- To evaluate vascular access methods and associated complications in pediatric hemodialysis patients.
Summary:
- A study of 60 pediatric patients (2-15 years) with ESRD undergoing hemodialysis in Chile.
- Glomerulopathies and reflux nephropathy were the leading causes of ESRD.
- Sixty-two percent of patients received renal grafts, while 25% remained on hemodialysis; complications included access issues (30%).
Impact:
- Highlights the critical role of hemodialysis as a bridge to renal transplantation in pediatric ESRD.
- Identifies key etiologies and demographic factors in pediatric ESRD.
- Suggests that advancements in pediatric hemodialysis technology and care can improve outcomes and reduce mortality.
Background:
The final objective of every children that is admitted to a program o hemodialysis of peritoneodialysis is to receive a renal graft.
Aim:
To report the experience in pediatric hemodialysis in two pediatric hospitals in Chile that are reference centers for renal transplantation.
Patients And Methods:
Sixty patients, 55% female, aged 2 to 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/1.73 m2, were studied.
Results:
Twenty percent of children were less than 5 years old at the moment of admittance to the program and 3.3% weighed less that 10 kg. Etiologies of end stage renal disease were glomerulopathies in 33.4%, reflux nephropathy in 27.7%, obstructive uropathy in 13.3%, hypoplasia/dysplasia in 10%, hereditary problems in 8.3% and vascular disorders in 5%. Eighty six percent of patients were dialyzed less than 2 years and 5% more than 4 years. Fifty percent had received prior medical treatment, 5% had been treated with intermittent peritoneal dialysis, 5% with chronic ambulatory peritoneal dialysis and 20% presented as a terminal renal failure. Sixty two percent received a renal graft, 25% is still on hemodialysis, 3.3% switched to chronic ambulatory peritoneal dialysis, 3.3% had a recovery of renal function and 6.7% died being on hemodialysis. Arterio-venous fistulae were the vascular accesses in 75% of patients, double lumen catheters in 50% and vein grafts in 5%. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30% of hospital admissions.
Conclusions:
The availability of new vascular accesses and new hemodialysis machines specially designed for children, along with specially trained health care personnel, should reduce the mortality and complication rates of hemodialysis in this age group.