Clinical Outcomes of Chronic Hemodialysis in Children Younger Than 2 Years or Weighing <10 kg: A Single-Center Comparative Study.

OBJECTIVE

Chronic hemodialysis (HD) in infants and small children is technically demanding, and data on treatment burden and clinical outcomes remain limited. This study compared treatment-related complications and outcomes in infants and small children receiving chronic HD with those in older children treated at the same center.

METHODS

This single-center retrospective cohort study evaluated all children who initiated chronic HD at a tertiary pediatric nephrology center between January 2015 and December 2025. The study group comprised 16 children who initiated HD before 2 years of age and/or at a body weight <10 kg and remained on HD for at least 3 months. The control group included all eligible children aged >2 years and weighing ≥10 kg who fulfilled the same minimum HD-duration criterion and initiated HD within 6 months before or after the HD initiation date of any study patient. This calendar-time sampling strategy yielded 36 contemporaneous controls. Growth, vascular access burden, anemia- and mineral and bone disorder-related parameters, kidney transplantation (KTx), and mortality were compared.

RESULTS

Median age at HD initiation was 1.0 year (IQR, 0.6; 1.9) in the study group and 14.4 years (IQR, 9.6; 16.4) in the control group (P < .001). The change in height standard deviation scores during HD follow-up did not differ significantly between groups. The study group had a higher catheter burden per patient-year, lower time-averaged hemoglobin, greater erythropoiesis-stimulating agent requirements, more frequent erythrocyte transfusions, higher timeaveraged parathyroid hormone levels, and lower calcitriol doses (all P < .05). No statistically significant differences were detected in KTx rate, time to transplantation, or mortality.

CONCLUSION

Chronic HD may provide a feasible bridge to KTX in selected infants and small children. No statistically significant differences in growth trajectories, transplantation, or mortality were observed between the groups. However, due to the small number of patients, this result should not be interpreted as evidence of equivalence. On the other hand, younger and smaller patients experienced greater vascular access and anemia-related treatment burdens, as well as a less favorable mineral and bone disorder profile.