title: The challenge of maintaining dialysis lines in the under twos.
abstract: BACKGROUND
  Hemodialysis (HD) and peritoneal dialysis (PD) are essential adjuncts in the management of children with established renal failure (ERF), but complications are common, particularly in the younger age groups. We reviewed catheter life and catheter-related complications in children who began chronic dialysis before the age of 2 years.
  
  
  METHODS
  From the case notes of the children, born between 1990 and 2008, the data gathered included etiology of ERF, age at first dialysis catheter, complications, catheter life, and number of PD and HD.
  
  
  RESULTS
  Ninety lines were inserted (40 PD and 50 HD) in 22 children with ERF. Eleven children were aged <6 months when commencing dialysis, six of whom were neonates. PD, the preferred modality, was offered to all but two children. Four children were managed with PD alone. One child died of overwhelming sepsis secondary to PD peritonitis. Average catheter life for HD was 3 months and PD 9.1 months. Luminal blockage and infection were the commonest reasons for change of HD catheters. Peritonitis was the commonest factor leading to PD removal.
  
  
  CONCLUSIONS
  Children younger than 2 years can be dialyzed successfully by HD or PD but complications are frequent, leading to >2 catheters in the majority. Chronic dialysis in the very young is achievable and useful, but a high incidence of catheter changes must be anticipated.
authors.affiliation: Department of Paediatric Urology, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK. dranupaul@gmail.com
authors.forename: Anu
authors.initials: A
authors.lastname: Paul
authors.forename: Nia
authors.initials: N
authors.lastname: Fraser
authors.forename: Sengamalai
authors.initials: S
authors.lastname: Manoharan
authors.forename: Alun R
authors.initials: AR
authors.lastname: Williams
authors.forename: Manoj U
authors.initials: MU
authors.lastname: Shenoy
mesh_terms: D002404:Catheterization / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D016208:Databases, Factual; D020878:Device Removal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D010538:Peritonitis / Q000209:etiology / Q000401:mortality; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D051437:Renal Insufficiency / Q000628:therapy*