Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes

Elizabeth Wright, Michel Fischbach, Ariane Zaloszyc, Fabio Paglialonga, Christoph Aufricht, Stephanie Dufek, Sevcan Bakkaloğlu, Günter Klaus, Aleksandra Zurowska, Mesiha Ekim, Gema Ariceta, Tuula Holtta, Augustina Jankauskiene, Claus Peter Schmitt, Constantinos J. Stefanidis, Johan Vande Walle, Karel Vondrak, Alberto Edefonti, Rukshana Shroff

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)137-143
Number of pages7
JournalPediatric Nephrology
Volume31
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

Keywords

  • Central venous line
  • Children
  • Hemodialysis
  • Seizures
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

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  • Cite this

    Wright, E., Fischbach, M., Zaloszyc, A., Paglialonga, F., Aufricht, C., Dufek, S., Bakkaloğlu, S., Klaus, G., Zurowska, A., Ekim, M., Ariceta, G., Holtta, T., Jankauskiene, A., Schmitt, C. P., Stefanidis, C. J., Walle, J. V., Vondrak, K., Edefonti, A., & Shroff, R. (2016). Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes. Pediatric Nephrology, 31(1), 137-143. https://doi.org/10.1007/s00467-015-3204-5