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The medium term outcome of chronic dialysis in children under the age of two
  1. H E Jones1,
  2. J C Clothier2,
  3. L Rees1,
  4. R Shroff1,
  5. S E Ledermann1,
  6. C J D Reid2,
  7. M D Sinha2,
  8. S Hulton3,
  9. C Inward4
  1. 1Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Trust, London, UK
  2. 2Department of Paediatric Nephrology, Evelina Children's Hospital, Guys and St. Thomas' NHS Foundation Trust, London, UK
  3. 3Department of Paediatric Nephrology, Birmingham Children's Hospital, Birmingham, UK
  4. 4Department of Paediatric Nephrology, Bristol Children's Hospital, Bristol, UK

Abstract

Aims Outcome data for children under the age of 2 years receiving renal replacement therapy is limited. The aim of this study was to examine modality, duration and outcome in this cohort.

Methods A retrospective case-note and UK Renal Registry review of all children commenced on dialysis for Chronic Kidney Disease stage 5 at under 2 years of age from two paediatric nephrology centres between January 2005 and December 2009. Data are presented as median (range).

Results 31 patients were identified (61% male). 48% were diagnosed antenatally. Commonest diagnoses were dysplasia±obstruction (45%), congenital nephrosis (23%) and metabolic (10%). 32% of patients had significant co-morbidities. Dialysis (peritoneal dialysis (PD) in 81%) was initiated at age 218 (3–634) days; 65% were aged <1 year. The weight at start was 7 kg (1.1–12.4 kg). 74% had a gastrostomy of which 48% were prior to and 52% after dialysis was commenced. Over 17.9 (1.1–57.8) months 42% of patients changed dialysis modality. Catheter related complications including peritonitis were common (46 episodes among 27 patients; 1 per 311 patient days on PD). Five PD patients had no infective episodes. Number of catheters required per patient was 2 (1–4) for PD and 4 (1–6) for haemodialysis. Time from initial PD catheter insertion to discharge home was 63 (7–140) days. Time on dialysis prior to transplantation was 492 (201–1161) days and spent in hospital pre-transplantation was 76 (13–199) days. As of 30 November 2010, 29% of patients remain on dialysis (55% awaiting a deceased donor transplant, 6% have planned living donor), 48% have received a functioning transplant (67% live-related) and 23% have died (1 treatment withdrawal, 3 sepsis, 1 bowel perforation, 2 perioperatively). The patients receiving a live-related transplant were 1.9 (1.5–2.3) years and 11.4 (10–13) kg at time of transplantation.

Conclusion Mortality and morbidity was high in this group of under 2 year olds in CKD 5. PD was the most common treatment but complications of dialysis were common, change of modality was frequently necessary and a significant amount of time was spent in hospital.

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