title: Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes.
abstract: BACKGROUND
  Hemodialysis (HD) in children with a concomitant ventriculoperitoneal shunt (VPS) is rare. Registry data suggest that peritoneal dialysis with a VPS is safe, but little is known about HD in the presence of a VPS.
  
  
  METHODS
  We performed a 10-year survey to determine the prevalence of a VPS, complications and outcome in children with a VPS on HD in 15 dialysis units from the 13 countries participating in the European Pediatric Dialysis Working Group.
  
  
  RESULTS
  Eleven cases of HD with a VPS were reported (prevalence 1.33 %; 328 patient-months) and compared with prospective Registry data. The median age at start of dialysis was 9.6 [inter-quartile range (IQR) 1.0-15.0] years and median HD vintage was 2.4 (IQR 1.7-3.0) years. Dialysis was performed through a central venous line (CVL) and through an arteriovenous fistula in six and five children, respectively. Three CVL infections occurred in two children, but these children did not develop VPS infections or meningitis. Symptoms of hemodynamic instability were reported in six (55 %) children at least once per week, with hypotension or hypertension occurring in four of these children and nausea, vomiting and headaches occurring in two; four other children reported less frequent symptoms. Seizures on dialysis occurred in two children, at a frequency of less than once per month, with one child also experiencing visual disturbances. During follow-up (median 4.0; IQR 0.38-7.63 years), three children remained on HD and eight had a functioning transplant. No patients were switched to PD.
  
  
  CONCLUSIONS
  Hemodialysis in children with a VPS is safe, but associated with frequent symptoms of hemodynamic instability. No episodes of VPS infection or meningitis were seen among the children in the survey, not even in those with CVL sepsis.
authors.affiliation: Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wright
authors.affiliation: Hopital de Hautepierre, Strasbourg, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Fischbach
authors.affiliation: Hopital de Hautepierre, Strasbourg, France.
authors.forename: Ariane
authors.initials: A
authors.lastname: Zaloszyc
authors.affiliation: Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.affiliation: University Hospital of Vienna, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Aufricht
authors.affiliation: Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Dufek
authors.affiliation: Ankara University Hospital, Ankara, Turkey.
authors.forename: Sevcan
authors.initials: S
authors.lastname: Bakkaloğlu
authors.affiliation: KfH Pediatric Kidney Center, Marburg, Germany.
authors.forename: Günter
authors.initials: G
authors.lastname: Klaus
authors.affiliation: Gdansk University Medical School, Gdansk, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zurowska
authors.affiliation: Gazi University Hospital, Ankara, Turkey.
authors.forename: Mesiha
authors.initials: M
authors.lastname: Ekim
authors.affiliation: University Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Ariceta
authors.affiliation: University of Helsinki, Helsinki, Finland.
authors.forename: Tuula
authors.initials: T
authors.lastname: Holtta
authors.affiliation: Vilnius University, Vilnius, Lithuania.
authors.forename: Augustina
authors.initials: A
authors.lastname: Jankauskiene
authors.affiliation: Center for Pediatric & Adolescent Medicine, Heidelberg, Germany.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Schmitt
authors.affiliation: "A & P Kyriakou", Children's Hospital, Athens, Greece.
authors.forename: Constantinos J
authors.initials: CJ
authors.lastname: Stefanidis
authors.affiliation: Universitair ziekenhuis Gent, Ghent, Belgium.
authors.forename: Johan Vande
authors.initials: JV
authors.lastname: Walle
authors.affiliation: University Hospital Motol, Prague, Czech Republic.
authors.forename: Karel
authors.initials: K
authors.lastname: Vondrak
authors.affiliation: Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.affiliation: Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK. Rukshana.Shroff@gosh.nhs.uk.
authors.forename: Rukshana
authors.initials: R
authors.lastname: Shroff
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation
keywords: Central venous line; Children; Hemodialysis; Seizures; Ventriculoperitoneal shunt