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. 2010 Jan;5(1):18-23.
doi: 10.2215/CJN.03670609. Epub 2009 Nov 12.

Renal replacement therapy in infants with chronic renal failure in the first year of life

Mirja Wedekin  1 , Jochen H H Ehrich, Gisela Offner, Lars Pape
Affiliations

Renal replacement therapy in infants with chronic renal failure in the first year of life

Mirja Wedekin et al. Clin J Am Soc Nephrol. 2010 Jan.

Abstract

Background and objectives: Although results of renal replacement therapy (RRT) in small children have improved during recent years, data about RRT in neonates are scarce.

Design, setting, participants, & measurements: In a retrospective study, we analyzed the outcome of infants who had chronic kidney disease and started RRT within their first year of life. Between 1997 and 2008, all 29 infants who were younger than 1 yr, had end-stage renal failure, and underwent RRT (dialysis or transplantation) at Hannover Medical School were analyzed for up to 12 yr.

Results: Twenty-seven of 29 infants with chronic kidney disease received peritoneal dialysis, starting at a mean age of 112 d; two children received preemptive renal transplantation (RTx). During follow-up, 21 of 29 children survived with RTx. The 5-yr patient and graft survival rate after RTx was 95.5%. Six of 29 children died, one with a functioning graft and five while on peritoneal dialysis. The main causes of death were severe cardiovascular and cerebral comorbidities. The mean GFR at last follow-up of patients who underwent RTx (mean time after RTx 5.1 yr) was 63.2 ml/min per 1.73 m(2).

Conclusions: RRT in infants who are younger than 1 year offers excellent chances of survival and should be offered to all infants who do not have severe, life-limiting extrarenal comorbidity. Contrary to previous observations, the long-term outcome of infants may be comparable to that of older children who undergo RRT.

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Figures

Figure 1.
Figure 1.
The outcome of 29 infants who had stage 5 CKD and started RRT in the first year of life.
Figure 2.
Figure 2.
The age at start of PD and RTx.
Figure 3.
Figure 3.
Cumulative patient survival of 29 infants who had CRF and received RRT in the first year of life.
Figure 4.
Figure 4.
Cumulative patient survival of 27 infants who had CRF and received RRT in the first year of life, excluding the two patients who had therapy withdrawn.
Figure 5.
Figure 5.
Individual course of GFR in infants who underwent RTx (n = 22).
See this image and copyright information in PMC

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