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Abstract: PO1966

Children on Chronic Hemodialysis Before the First Year of Age: A Three-Year Survival Analysis

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Henriques, Cristina, Hospital Samaritano de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Roizenblatt, Arnaldo, Universidade Federal de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Carvalho, Maria fernanda Camargo, Hospital Samaritano de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  • Takihi, Fabio Akio, Universidade Federal de Sao Paulo, Sao Paulo, São Paulo, Brazil
  • Koch Nogueira, Paulo C., Hospital Samaritano de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
Background

Peritoneal dialysis is the method of choice for infants who need renal replacement therapy (RRT). However, when it is not possible to perform it or becomes ineffective, hemodialysis is a feasible method in young children.
There are few reports on the survival rate of children undergoing hemodialysis in the first year of life. The goal of this study was to determine the mortality rate and its risk factors in children starting hemodialysis during their first year of life.

Methods

We performed a retrospective cohort study, based on data from a reference Dialysis Center in São Paulo city. Data from 47 (8 females) children who underwent chronic hemodialysis before the first year of age were analyzed. Survival was characterized using Kaplan-Meier methods and log-rank tests, followed by a multivariable Cox regression model.

Results

The median weight on the first hemodialysis session was 4.3 Kg (IQR=3.4 to 5.3), while median age was 4.1 months (IQR=2.3 to 6.0), with 21 children younger than 1 month, and only one older than 6 months.
Patients were categorized according to the etiology of Chronic Kidney Disease (CKD), congenital anomalies of the kidneys and urinary tract (53.2%) was the most prevalent cause, followed by congenital renal dysplasia (23.4%), autosomal recessive polycystic kidney disease (8.5%), and other etiologies (14.9%).
The survival rates were 93%, 75%, and 64% at 1, 2, and 3 years, respectively. Only cardiovascular comorbidity was significantly associated with the death outcome (HR=5.7, 95%CI=1.7 – 19.6, p=0.006). Anuria had a significant impact on survival only in univariate analysis.
Parameters such as gender, age at hemodialysis onset, ethnicity, early dialysis, etiology of CKD had no impact on survival.

Conclusion

Our retrospective cohort gathers an expressive number of children with this rare and severe condition of early onset of hemodialysis, with a uniform follow-up of all individuals
We observed satisfactory survival rates among children who started hemodialysis in their first year of life, comparable to the standards of the international pediatric dialysis centers. Hemodialysis became a safe method in young children until the performance of kidney transplantation.