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小儿慢性血液透析:意大利儿科透析登记处的回顾性研究

Chronic haemodialysis in small children: a retrospective study of the Italian Pediatric Dialysis Registry.

作者信息

Paglialonga Fabio, Consolo Silvia, Pecoraro Carmine, Vidal Enrico, Gianoglio Bruno, Puteo Flora, Picca Stefano, Saravo Maria Teresa, Edefonti Alberto, Verrina Enrico

机构信息

Pediatric Nephrology and Dialysis Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy.

Nephrology and Dialysis Unit, Santobono Children's Hospital, Naples, Italy.

出版信息

Pediatr Nephrol. 2016 May;31(5):833-41. doi: 10.1007/s00467-015-3272-6. Epub 2015 Dec 21.

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.

摘要

背景

幼儿慢性血液透析(HD)尚未得到充分研究。

方法

这是一项对21名年龄小于2岁(12名年龄小于1岁)的儿童进行慢性HD治疗的回顾性调查,这些儿童登记在意大利儿科透析登记处。对超过10年收集的数据进行了分析。

结果

21名儿童开始HD治疗时的中位年龄为11.4[四分位间距(IQR)6.2 - 14.6]个月,HD主要包括每周≥4次、每次3 - 4小时的血液透析滤过。共放置了51根中心静脉导管,隧道式和临时导管的中位生存期分别为349天和31天(p < 0.001)。8名儿童(38%)有中心静脉血栓形成的证据。虽然19%的患者接受了生长激素治疗,63.6%的患者接受了肠内营养,但这些患者的体重和身高仍不理想。在HD治疗期间,所有患者的血红蛋白水平均有所上升,但尽管给予了促红细胞生成素(503 - 600 U/kg/周),仍未达到正常水平(从8.5 g/dl升至9.6 g/dl)。住院率为1.94/患者年。17名患者在中位年龄3.0岁时接受了肾移植。4名患者,均患有严重合并症,在随访期间死亡(2例死于缺乏血管通路)。5年和10年累积生存率分别为82.4%和68.7%。

结论

体外透析在2岁以下儿童中是可行的,但合并症、血管通路、生长和贫血仍是主要问题。

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