Hemodiálisis crónica en pediatría / Chronic hemodialysis in children

RESUMO

Background: The final objective of every children that is admitted to a program o hemodialysis or peritoneodialysis is to receive a renal graft. Aim: To report the experience in pediatric hemodialysis in two pediatric hospitals in Chile that are reference centers for renal transplantation. Patients and methods: Sixty patients, 55 percent female, aged 2 to 15 years old, admitted to the dialysis and transplant program since 1987, with a creatinine clearance of less than 20 ml/min/l.73 m2, were studied. Results: Twenty percent of children were less than 5 years old at the moment of admittance to the program and 3.3 percent weighed less than 10 kg. Etiologies of end stage renal disease were glomerulopathies in 33.4 percent, reflux nephropathy in 27.7 percent, obstructive uropathy in 13.3 percent, hypoplasia/dysplasia in 10 percent, hereditary problems in 8.3 percent and vascular disorders in 5 percent. Eighty six percent of patients were dialyzed less than 2 years and 5 percent more than 4 years. Fifty percent had received prior medical treatment, 5 percent bad been treated with intermittent peritoneal dialysis, 5 percent with chronic ambulatory peritoneal dialysis and 20 percent presented as a terminal renal failure. Sixty two percent received a renal graft, 25 percent is still on hemodialysis, 3.3 percent switched to chronic ambulatory peritoneal dialysis, 3.3 percent had a recovery of renal function and 6.7 percent died being on hemodialysis. Arterio-venous fistulae were the vascular accesses in 75 percent of patients, double lumen catheters in 50 percent and vein grafts in 5 percent. Malfunctioning or infections were the main complications of arterio-venous fistulae, accounting for 30 percent of hospital admissions. Conclusions: The availability of new vascular accesses and new hemodialysis machines specially designed for chndren, along with specially trained health care personnel, should reduce the mortality and complication rates of hemodialysis in this age group