Abstract: TH-PO796

Outcomes of Chronic Dialysis in Infants under Two Years

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Teoh, Chia Wei, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Jawa, Natasha, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Gallibois, Claire Marie, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Noone, Damien Gerard, The Hospital for Sick Children, Toronto, Ontario, Canada
Background

Infants with end-stage renal disease require renal replacement therapy in the form of dialysis, until of sufficient weight to be transplanted; typically by age two. Infant dialysis is associated with significant morbidity and mortality. Peritoneal dialysis (PD) has historically been the preferred choice for infant dialysis, due to technical complexities and risk for complications associated with hemodialysis (HD). Management of very young patients on HD has improved in recent years, but outcomes have yet to be assessed. This study retrospectively reviewed long-term patient- and dialysis-specific outcomes of chronic PD and HD in a contemporary cohort of infants less than two years of age and weighing <10 kg at The Hospital for Sick Children, Toronto.

Methods

Infants <2 years of age and <10 kg undergoing chronic dialysis from 2005-2015 were included. Demographic, dialysis-related and outcome data were extracted from patient’s electronic medical records. Summary statistics were analyzed using STATA v.14. Median with interquartile range is provided.

Results

A total of 28 infants (64.3% male) were included. 20 (71.4%) were diagnosed antenatally. Time from birth to dialysis initiation was 13.5 (10, 67) days. 14 (50%) were initiated on PD and 14 (50%) on HD. 8 infants switched modalities a median of 3 (2, 11) times. In patients on PD, the rate of peritonitis was 1 episode/22 patient months. In patients on HD, 11 (64.7%) required a central line change and the central line associated blood stream infection (CLABSI) rate was 1.48 per 1000 central line days. Median time in hospital from dialysis initiation until death/transplant was 8.5 (3.6, 16.7) months. 6 (21.4%) infants died, 17 (61%) were transplanted and 5 (17.9%) remain on dialysis at study end. In those receiving a transplant, median time to transplantation was 2.1 (1.8, 2.7) years.

Conclusion

There has been an increase in the use of HD in recent years. Survival and transplantation rates have improved over time as compared to previously reported rates; however this is associated with prolonged hospital stays and multiple switches between dialysis modalities.