The outcome of chronic dialysis in infants and toddlers--advantages and drawbacks of haemodialysis.

Background: Improvements in dialysis technology allow replacement therapy for even the youngest of children with end stage renal disease. Nevertheless, the cumulative experience in this age group is limited.

Methods: We compared the outcome of 20 children who initiated chronic dialysis before the age of 1 year (weight 4.9 +/- 2 kg, Group 1), with a particular focus on those under the age of 1 month (eight children, weight 2.9 +/- 0.34), to that of 14 patients, aged 1.1-3 years when starting dialysis (weight 10.1 +/- 1.7, Group 2).

Results: The outcome was poor in the youngest age group; only 3/8 survived to 3 years. Of those who started dialysis between the ages of 0.3 and 3 years, 84% underwent kidney transplantation. One-, three-, five-, and eight-year patient survival was 96%, 88%, 84% and 84% respectively [corrected] Severe co-morbidities were present in almost half of those who died. Hospital stay was 3.5 times longer in Group 1 than in Group 2 during the first 3 months of dialysis. Permanent central venous catheters inserted under ultrasound guidance resulted in a 4.4-fold increase in catheter survival compared to non-cuffed catheters. Marked blood loss at beginning of haemodialysis (HD) is attributable to residual volume in the dialysis system (15.7 mL/kg/month) and frequent blood tests (12.1 +/- 5.9 mL/kg/month). These values decreased 2-fold after 8 months of treatment.

Conclusions: The main factors determining the poor outcome of infants on dialysis are extremely young age at initiation and severe co-morbidities. Despite some disadvantages, HD may be successfully implemented in infants and toddlers, in highly specialized centres with a well-trained nursing staff.