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Hemodialysis for children with chronic kidney disease

Lesley Rees, MD, FRCPCH
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Chronic hemodialysis (HD) is technically feasible in children of all ages, and even in very small neonates [1]. Although the principles of HD are similar for adults and children, there are technical aspects of the procedure and complications that are unique to the pediatric population. It is crucial that these differences are recognized and addressed in order to effectively and safely perform pediatric HD, thereby reducing complications in children who are facing a lifetime of renal replacement therapy (RRT).

Hemodialysis in children with chronic kidney disease (CKD), including discussions on types of vascular access and dialyzers, dialysis prescription, and complications, will be reviewed here. Overviews on the management of pediatric CKD and RRT are discussed separately. (See "Overview of the management of chronic kidney disease in children" and "Overview of renal replacement therapy (RRT) for children with chronic kidney disease".)


The goals of pediatric HD are the same as those in adults undergoing HD: effective and safe clearance of uremic toxins, and removal of excess fluid, with the additional need for preservation of blood vessels to allow for a lifetime of renal replacement therapy (RRT). The principles of HD and a general description of HD apparatus are discussed separately. (See "Overview of the hemodialysis apparatus".)

The following aspects of HD, which may differ in adults and children, need to be considered and addressed in order to effectively and safely perform pediatric HD:

Vascular access

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Literature review current through: Nov 2017. | This topic last updated: Jun 29, 2017.
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