Evolution and change in paradigm of hemodialysis in children: a systematic review
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ORIGINAL ARTICLE
Evolution and change in paradigm of hemodialysis in children: a systematic review Rahul Chanchlani 1,2 & Claire Young 3 & Aisha Farooq 3 & Stephanie Sanger 3 & Sidharth Sethi 4 & Ronith Chakraborty 5 & Abhishek Tibrewal 6 & Rupesh Raina 5,7 Received: 20 June 2020 / Revised: 29 September 2020 / Accepted: 12 October 2020 # IPNA 2020
Abstract Background There are similarities in hemodialysis (HD) between adults and children and also unique pediatric aspects. In this systematic review, we evaluated the existing HD literature, including vascular access, indications, parameters, and outcomes as a reflection on real-life HD practices. Methods Medline, Embase, CINAHL, Web of Science, and Cochrane Library were systematically searched for literature on HD in children (1–20 years). Two reviewers independently assessed the literature and data on indications; vascular access, outcomes, and specific parameters for HD were extracted. Results Fifty-four studies (8751 patients) were included in this review. Studies were stratified into age groups 1–5, 6–12, and 13–20 years based on median/mean age reported in the study, as well as era of publication (1990–2000, 2001–2010, and 2011–2019). Across all age groups, both arteriovenous fistulas and central venous catheters were utilized for vascular access. Congenital abnormalities and glomerulopathy were the most common HD indications. HD parameters including HD session duration, dialysate and blood flow rates, urea reduction ratio, and ultrafiltration were characterized for each age group, as well as common complications including catheter dysfunction and intradialytic hypotension. Median mortality rates were 23.3% (3.3), 7.6% (14.5), and 2.0% (3.0) in ages 1–5, 6–12, and 13–20 years, respectively. Median transplantation rates were 41.6% (38.3), 52.0% (32.0), and 21% (25.6) in ages 1–5, 6–12, and 13–20, respectively. Conclusion This comprehensive systematic review summarizes available literature on HD in children and young adults, including best vascular access, indications, technical aspects, and outcomes, and reflects on HD practices over the last three decades. Keywords Hemodialysis . Children . Pediatric . Kidney failure . Acute kidney injury
Rahul Chanchlani and Claire Young contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00467-020-04821-y) contains supplementary material, which is available to authorized users. * Rupesh Raina [email protected]; [email protected] 1
2
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Department of Pediatrics, McMaster Children’s Hospital, Hamilton, Ontario, Canada Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
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Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA
6
Gurugram, India
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