Abstract: FR-PO1161
Analysis of Survival of Low Weight Children (<15 kg) Undergoing Chronic Hemodialysis: Mortality and Risk Factors
Session Information
- Pediatric Nephrology - I
October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1600 Pediatric Nephrology
Authors
- Henriques, Cristina, Hospital Samaritano, Sao Paulo, Brazil
- Vieira, Simone, Hospital Samaritano, Sao Paulo, Brazil
- Komi, Shirlei, Hospital Samaritano, Sao Paulo, Brazil
- Carvalho, Maria fernanda Camargo, Hospital Samaritano, Sao Paulo, Brazil
- Koch nogueira, Paulo Cesar, UNIFESP, Sao Paulo, Brazil
Background
With the technological advances in hemodialysis, it is currently possible to offer this type of therapy to young and low weight children. Our objective is to analyze the survival of children undergoing hemodialysis and risk factors impacting mortality
Methods
Retrospective analysis of patients undergoing chronic hemodialysis between January 2015 and January 2018 was performed. The sample included 65 patients (14F and 51M) with median age at start of hemodialysis of 1.3 years (13 days - 9.6 years) and median follow-up of 536 days (54 days - 5.2 years). The most frequent etiology was CAKUT (63%) followed by Renal Dysplasia (8%). At study baseline, median weight was 8.1Kg (2.3kg-13.7kg), median Z-score for weight/age -3.94 and median Z-score for height/age -3.16. Enteral feeding was required in 32 patients via gastrostomy. In this sample, 30 patients had anuria and 43 patients had undergone peritoneal dialysis prior to hemodialysis. 61 patients were on daily hemodialysis (8 patients had 7 sessions/week) with 90-180 minute sessions according to individual needs. Vasoactive drugs to maintain adequate blood pressure for the procedure were required in 26 patients.
Results
Of the 65 patients, 30 (46%) were transplanted, 27 (42%) remained on HD and 8 (12%) died. The cumulative survival rate was 96% for 1-year, 86% for 2-year, 80% for 3-year and 70% for 5-year survival. Considering transplant as a concurrent event, the following factors had the greatest impact:
a) Cardiopathy – presence associated with a 23 times greater probability of death (95%CI= 5 - 103; p<0.001)
b) Anuria – presence associated with an 8 times greater probability of death (95%CI = 1 - 67; p=0.050)
c) Z-score for height/age - every 1 SD increase in Z-score reduced chance of death by 46% (95%CI = 16% - 66%; p=0.006)
d) Z-score for weight/age - every 1 SD increase in Z-score reduced chance of death by 56% (95%CI = 33% - 71%; p<0.001)
Conclusion
Hemodialysis is a viable therapy in low weight children awaiting kidney transplant. Survival rates found were similar to those reported in the literature. The presence of cardiopathy risk factor had the greatest impact on probability of death in the sample. The patients with highest survival rates were those with better nutritional status and residual renal function.