Hemodialysis in children with ventriculoperitoneal shunts: prevalence, management and outcomes.
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.
['Wright|Elizabeth|E|', 'Fischbach|Michel|M|', 'Zaloszyc|Ariane|A|', 'Paglialonga|Fabio|F|', 'Aufricht|Christoph|C|', 'Dufek|Stephanie|S|', 'Bakkaloğlu|Sevcan|S|', 'Klaus|Günter|G|', 'Zurowska|Aleksandra|A|', 'Ekim|Mesiha|M|', 'Ariceta|Gema|G|', 'Holtta|Tuula|T|', 'Jankauskiene|Augustina|A|', 'Schmitt|Claus Peter|CP|', 'Stefanidis|Constantinos J|CJ|', 'Walle|Johan Vande|JV|', 'Vondrak|Karel|K|', 'Edefonti|Alberto|A|', 'Shroff|Rukshana|R|', '|||']
D000293:Adolescent D000367:Age Factors D001166:Arteriovenous Shunt, Surgical D055499:Catheter-Related Infections D002405:Catheterization, Central Venous D002408:Catheters, Indwelling D062905:Central Venous Catheters D002648:Child D002675:Child, Preschool D005060:Europe D005260:Female D019538:Health Care Surveys D006801:Humans D006973:Hypertension D007022:Hypotension D007223:Infant D016030:Kidney Transplantation D008297:Male D006435:Renal Dialysis D051436:Renal Insufficiency, Chronic D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D012640:Seizures D011795:Surveys and Questionnaires D013997:Time Factors D016896:Treatment Outcome D017287:Ventriculoperitoneal Shunt
Hemodialysis Children Ventriculoperitoneal shunt Central venous line Seizures