title: Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry.
abstract: BACKGROUND
  Chronic haemodialysis (HD) in small children has not been adequately investigated.
  
  
  METHODS
  This was a retrospective investigation of the use of chronic HD in 21 children aged  <2 years (n = 12 aged <1 year) who were registered in the Italian Pediatric Dialysis Registry. Data collected over a period of >10 years were analysed.
  
  
  RESULTS
  The median age of the 21 children at start of HD was 11.4 [interquartile range (IQR) 6.2-14.6] months, and HD consisted mainly of haemodiafiltration for 3-4 h in  ≥4 sessions/week. A total of 51 central venous catheters were placed, and the median survival of tunnelled and temporary lines was 349 and 31 days, respectively (p  < 0.001). Eight children (38 %) showed evidence of central vein thrombosis. Although 19 % of patients received growth hormone and 63.6 % received enteral feeding, the weight and height of these patients remained suboptimal. During the HD period the haemoglobin level increased in all patients, but not to normal levels (from 8.5 to 9.6 g/dl) despite erythropoietin administration (503-600 U/kg/week). The hospitalisation rate was 1.94/patient-year. Seventeen patients underwent renal transplantation at a median age of 3.0 years. Four patients, all affected by severe comorbidities, died during follow-up (in 2 cases due to absence of a vascular access). The 5- and 10-year cumulative survival was 82.4 and 68.7 %, respectively.
  
  
  CONCLUSIONS
  Extracorporeal dialysis is feasible in children aged  <2 years, but comorbidities, vascular access, growth and anaemia remain major concerns.
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabiopaglialonga@alice.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Paglialonga
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Consolo
authors.affiliation: Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Pecoraro
authors.affiliation: Pediatric Nephrology, Dialysis and Transplant Unit, Department of Women's and Children's Health, University Hospital Padua, Padua, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vidal
authors.affiliation: Nephrology Dialysis and Transplantation Unit, Regina Margherita University Hospital, Turin, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gianoglio
authors.affiliation: Nephrology Division, Giovanni XXIII Children's Hospital, Bari, Italy.
authors.forename: Flora
authors.initials: F
authors.lastname: Puteo
authors.affiliation: Nephrology and Dialysis Unit, Department of Nephrology-Urology, IRCCS "Bambino Gesù" Children's Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Picca
authors.affiliation: Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Saravo
authors.affiliation: Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Edefonti
authors.affiliation: Dialysis Unit, Paediatric Nephrology and Dialysis Department, IRCCS Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
mesh_terms: D000367:Age Factors; D000740:Anemia / Q000209:etiology; D001827:Body Height; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002657:Child Development; D002675:Child, Preschool; D015897:Comorbidity; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D017583:Hemodiafiltration / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain
keywords: Central venous catheter; Extracorporeal dialysis; Haemodiafiltration; Paediatric dialysis modality; Young children