Elizabeth Wright1, Michel Fischbach2, Ariane Zaloszyc2, Fabio Paglialonga3, Christoph Aufricht4, Stephanie Dufek1, Sevcan Bakkaloğlu5, Günter Klaus6, Aleksandra Zurowska7, Mesiha Ekim8, Gema Ariceta9, Tuula Holtta10, Augustina Jankauskiene11, Claus Peter Schmitt12, Constantinos J Stefanidis13, Johan Vande Walle14, Karel Vondrak15, Alberto Edefonti3, Rukshana Shroff16. 1. Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK. 2. Hopital de Hautepierre, Strasbourg, France. 3. Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milan, Italy. 4. University Hospital of Vienna, Vienna, Austria. 5. Ankara University Hospital, Ankara, Turkey. 6. KfH Pediatric Kidney Center, Marburg, Germany. 7. Gdansk University Medical School, Gdansk, Poland. 8. Gazi University Hospital, Ankara, Turkey. 9. University Hospital Vall d'Hebron, Barcelona, Spain. 10. University of Helsinki, Helsinki, Finland. 11. Vilnius University, Vilnius, Lithuania. 12. Center for Pediatric & Adolescent Medicine, Heidelberg, Germany. 13. "A & P Kyriakou", Children's Hospital, Athens, Greece. 14. Universitair ziekenhuis Gent, Ghent, Belgium. 15. University Hospital Motol, Prague, Czech Republic. 16. Nephro-Urology Unit, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, UK. Rukshana.Shroff@gosh.nhs.uk.
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.
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.
Entities:
Keywords:
Central venous line; Children; Hemodialysis; Seizures; Ventriculoperitoneal shunt
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