Surgical aspects of dialysis in newborns and infants weighing less than ten kilograms

Purpose: Renal failure occurs in children with moderate frequency. Surgical aspects of establishing and maintaining dialysis access in small infants a re exceptionally challenging. The purpose of this review is to evaluate the authors' experience with dialysis access for infants less than 10 kg, part icularly with respect to the surgical care required. Methods: A retrospective review was conducted between 1991 and 1999 of all pediatric dialysis patients weighing 10 kg or less (n = 29). Age at start o f dialysis, duration of dialysis, modes of dialysis, and complications spec ific to peritoneal (PD) and hemodialysis (HD) were examined. Results: The mean age at start of dialysis was 10.4 months and continued fo r an average duration of 16.3 months. Seventy-two percent of all patients r equired both modes of dialysis, HD and PD duration averaged 7.8 and 10.5 mo nths, respectively. Catheter durability was 3.1 and 4.5 months per catheter for HD and PD, respectively. There was no significant difference in compli cations when comparing HD and PD. Patients who weighed 5 to 10 kg had signi ficantly longer PD catheter durability than patients 0 to 5 kg (P = .001). Forty-one percent of patients terminated dialysis after transplantation, wh ereas 24% died awaiting transplantation. Conclusion: Despite a large number of operations required, infants less tha n 10 kg can be bridged successfully, by surgical intervention and subsequen t dialysis, to transplantation. Copyright (C) 2000 by W.B. Saunders Company .