ABSTRACT
Background: Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are major health care problems worldwide even in Pediatric population. The etiology of CKD in children with ESRD is varied. Most of them are started on peritoneal dialysis or hemodialysis before being considered for renal transplantation.The aims and objective of this study was to analyzed the patient group, methodology, results and outcomes of hemodialysis catheter insertion and continuous ambulatory peritoneal dialysis (CAPD) catheter insertion for children with ESRD. The etiology of ESRD in children with CKD is also reviewed.Methods: All children with ESRD who underwent CAPD catheter and haemodialysis catheter insertion over a period of 5 years were included in the study. CAPD catheters were inserted by open and laparoscopic assisted methods. The procedures were done without image guidance due to logistical constraints in a limited resource scenario. Analysis of all relevant case records, operative notes and postoperative events were done.Results: A total of 40 patients who underwent CAPD and hemodialysis catheter insertions were analysed. The primary cases (no previous insertion of dialysis catheter) included 29 and secondary cases (history of previous insertion of dialysis catheter) were 7. Re-insertions (of the same type of dialysis catheter) were 2 in each group. No significant complications occurred in either group.Conclusions: Dialysis catheters for ESRD in Paediatric population can be inserted safely even without image guidance and with very few complications.
ABSTRACT
Haemodialysis catheters are frequently used in patients with end-stage renal failure prior to the formation of an arterio-venous shunt. Right atrial thrombus can developed in some patients receiving haemodialysis through indwelling central line venous catheter (CVC). Thrombus formation can developed in response to intraluminal clot formation or endothelial damage in the right atrium caused by the constant friction between catheter and right atrial wall. Three patients developed right atrial thrombus after undergoing haemodialysis due to end stage renal failure. Out of three cases of RAT, one of them was infected. The three cases managed medically. No surgical intervention was required. The indication for routine echocardiographic screening in patients with hemodialysis catheter might be an option to detect RAT earlier; however, its role will remain controversial due to the cost reasons.