Hemodialysis for end-stage renal disease in children weighing less than 10kg

Hemodialysis (HD) of infants with end-stage renal disease (ESRD) is technic ally difficult and labor intensive, although there are few data in the lite rature to document the outcomes of this treatment. We retrospectively revie wed all patients with ESRD who received HD between 1983 and 1997 who weighe d <10 kg at the beginning of HD. A total of ten patients aged 2-27 months;, weighing 3.5-9.5 kg, were identified. All patients were dialyzed through a central venous line; three had a failed sapheno-femoral loop and one a fai led brachial shunt. Line clot was observed in nine and line sepsis in six p atients. Subclavian vein stenosis was documented in one patient following r emoval of a clotted subclavian line. The mean urea reduction ratios calcula ted during the Ist and 3rd month of HD were only 54% and 49%,, respectively . Anemia was a frequent problem, despite the use of erythropoietin in seven of the infants;. Outcomes included: successful renal transplant in four, s witch back to peritoneal dialysis in two, improved renal function and dialy sis discontinuation in one, and death after withdrawal of treatment in thre e patients. All three patients who died were <5 months of age, weighed <5 k g, and were anuric; two of the three had congenital nephrotic syndrome. In conclusion, successful HD is possible in small children with ESRD, but morb idity is substantial and mortality is high.