Abstract
Advanced renal failure in infancy represents a difficult therapeutic dilemma, particularly when it rapidly advances to end-stage renal disease (ESRD) during the neonatal period (1–3). Once ESRD is reached (creatinine clearance of around 5 ml/min/1.73m2), most patients require the institution of some kind of renal replacement therapy. The latter can be offered through either hemodialysis or peritoneal dialysis. Hemodialysis requires the passage of a given extracorporeal blood volume through a filter (dialyzer), and is usually performed during three weekly sessions of two to four hours duration each. Although extensively used in children, adolescents, and adults, its implementation in small infants has been limited (4). This is mainly due to the infantl’s small vessel size and circulating volume. Thus, the surgical creation of an adequate vascular access, and the presence of a large extracorporeal blood volume during dialysis, turn hemodialyis into a rather cumbersome proposition. In addition, infants are particularly susceptible to rapid transcellular volume and solute shifts (disequilibrium) (4), and the life of vascular accesses is relatively shortened as compared to larger patients. Therefore, very few infants have been maintained on hemodialysis for prolonged periods of time.