Surgical aspects of dialysis in newborns and infants weighing less than ten kilograms.
OBJECTIVE
Renal failure occurs in children with moderate frequency. Surgical aspects of establishing and maintaining dialysis access in small infants are exceptionally challenging. The purpose of this review is to evaluate the authors' experience with dialysis access for infants less than 10 kg, particularly with respect to the surgical care required.


METHODS
A retrospective review was conducted between 1991 and 1999 of all pediatric dialysis patients weighing 10 kg or less (n = 29). Age at start of dialysis, duration of dialysis, modes of dialysis, and complications specific to peritoneal (PD) and hemodialysis (HD) were examined.


RESULTS
The mean age at start of dialysis was 10.4 months and continued for an average duration of 16.3 months. Seventy-two percent of all patients required both modes of dialysis. HD and PD duration averaged 7.8 and 10.5 months, respectively. Catheter durability was 3.1 and 4.5 months per catheter for HD and PD, respectively. There was no significant difference in complications when comparing HD and PD. Patients who weighed 5 to 10 kg had significantly longer PD catheter durability than patients 0 to 5 kg (P = .001). Forty-one percent of patients terminated dialysis after transplantation, whereas 24% died awaiting transplantation.


CONCLUSIONS
Despite a large number of operations required, infants less than 10 kg can be bridged successfully, by surgical intervention and subsequent dialysis, to transplantation.
Beanes
S R
SR
Department of Surgery, UCLA School of Medicine, Los Angeles, CA 90095, USA.
Kling
K M
KM
Fonkalsrud
E W
EW
Torres
M
M
Salusky
I B
IB
Quinones-Baldrich
W J
WJ
Atkinson
J B
JB
D001835:Body Weight; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010530:Peritoneal Dialysis / Q000379:methods* / Q000401:mortality; D011336:Probability; D006435:Renal Dialysis / Q000379:methods*; D051437:Renal Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome