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Evolution and change in paradigm of hemodialysis in children: a systematic review

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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.

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Data availability

All data involved in this systematic review can be found within the article and/or in online supplementary material.

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Acknowledgments

Work of CY was supported by the Michael G. DeGroote School of Medicine–McMaster Medical Student Research Excellence Awards.

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Author notes

  1. Rahul Chanchlani and Claire Young contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatrics, McMaster Children’s Hospital, Hamilton, Ontario, Canada

    Rahul Chanchlani

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

    Rahul Chanchlani

  3. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Claire Young, Aisha Farooq & Stephanie Sanger

  4. Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India

    Sidharth Sethi

  5. Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA

    Ronith Chakraborty & Rupesh Raina

  6. Gurugram, India

    Abhishek Tibrewal

  7. Department of Nephrology, Akron Children’s Hospital, Akron, OH, USA

    Rupesh Raina

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  1. Rahul Chanchlani
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Contributions

All authors contributed to this manuscript and approved the final version. S. Sanger performed database search; C. Y. and A. F. independently reviewed literature and completed data extraction with assistance from R. Chanchlani. C.Y. and A.F. drafted the initial manuscript; A. T. completed statistical analysis and figure preparation. R. R., R. Chanchlani, R. Chakraborty, S. Sethi, and A. T. provided data interpretation and analysis, figure preparations, manuscript revisions, and critical feedback.

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Correspondence to Rupesh Raina.

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Chanchlani, R., Young, C., Farooq, A. et al. Evolution and change in paradigm of hemodialysis in children: a systematic review. Pediatr Nephrol 36, 1255–1271 (2021). https://doi.org/10.1007/s00467-020-04821-y

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