title: Long-term hemodialysis therapy in neonates and infants with end-stage renal disease: a 16-year experience and outcome.
abstract: BACKGROUND
  Peritoneal dialysis is the preferred mode of renal replacement therapy in infants with end-stage renal disease (ESRD). Hemodialysis (HD) is seldom used in neonates and infants due to the risk of major complications in the very young.
  
  
  METHODS
  Demographic, clinical, laboratory, and imaging data on all infants younger than 12 months with ESRD who received HD in our Pediatric Dialysis Unit between January 1997 and June 2013 were analyzed.
  
  
  RESULTS
  Eighteen infants (n = 6 male) with ESRD (median age 3 months; median weight 4.06 kg) received HD through a central venous catheter (CVC) for a total of 543 months (median duration per infant 16 months). Seven of the infants (39%) were neonates, and five (28%) had serious comorbidities. There were five episodes of CVC infection, which is a rate of 0.3/1000 CVC days. Median catheter survival time was 320 days. Most infants had good oral intake, and only four (22%) required a gastric tube; 14 (78%) infants displayed normal growth. Fourteen (78%) infants had hypertension, of whom four (22%) had severe cardiac complications; eight (44%) showed delayed psychomotor development. Eleven (61%) of the infants, including six (86%) of the neonates, survived. Five (28%) infants underwent renal transplantation; 10-year graft survival was 80%.
  
  
  CONCLUSIONS
  Based on these results, long-term HD in neonates and infants with ESRD is technically feasible, can be implemented without major complications, carries a very low rate of CVC infection and malfunction, and results in adequate nutrition, good growth, as well as good kidney graft and patient survivals. Future efforts should aim to prevent hypertension and its cardiac sequelae, improve neurodevelopmental outcome, and lower mortality rate in these infants.
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel.|Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Shirley
authors.initials: S
authors.lastname: Pollack
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel.|Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Eisenstein
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Tarabeih
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel.
authors.forename: Hadas
authors.initials: H
authors.lastname: Shasha-Lavski
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel.|Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors.forename: Daniella
authors.initials: D
authors.lastname: Magen
authors.affiliation: Division of Pediatric Nephrology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, P.O. Box 9602, Haifa, 3109601, Israel. israelz@tx.technion.ac.il.|Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. israelz@tx.technion.ac.il.
authors.forename: Israel
authors.initials: I
authors.lastname: Zelikovic
mesh_terms: D055499:Catheter-Related Infections / Q000209:etiology / Q000401:mortality; D002405:Catheterization, Central Venous; D062905:Central Venous Catheters; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Central venous catheter; Growth; Neurodevelopmental outcome; Renal replacement therapy; Renal transplantation; Survival