CHRONIC-HEMODIALYSIS IN CHILDREN

Background: The final objective of every children that is admitted to a program o hemodialysis or peritoneodialysis is to receive a renal gr aft. Aim: To report the experience to pediatric hemodialysis in two pe diatric hospitals in Chile that are reference centers for renal transp lantations. Patients and methods: Sixty patients, 55% female, aged 2 t o 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/1.73 m(2), we re 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 than 10 kg. Etiologies of end stage renal disease were glomerulopathie s in 33.4%, reflux nephropathy in 27.7%, obstructive uropathy in 13.3% , hypoplasia/dysplasia in 10%, hereditary problems in 8.3% and vascula r disorders in 5%. Eighty six percent of patients were dialyzed less t han 2 years and 5% more than 4 years. Fifty percent had received prior medical treatment, 5% had been treated with intermittent peritoneal d ialysis, 5% with chronic ambulatory peritoneal dialysis and 20% presen ted as a terminal renal failure. Sixty two percent received a renal gr aft, 25% is still on hemodialysis, 3.3% switched to chronic ambulatory peritoneal dialysis, 3.3% had a recovery of renal function and 6.7% d ied being on hemodialysis. Arterio-venous fistulae were the vascular a ccesses in 75% of patients, double lumen catheters in 50% and vein gra fts in 5%. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30% of hospital admissions. C onclusions: The availability of new vascular accesses and new hemodial ysis machines specially designed for children, along with specially tr ained health care personnel, should reduce the mortality and complicat ion rates of hemodialysis in this age group.