Categories: Nephrology

Dialysis in Children

What is dialysis?

Dialysis is a life-saving medical procedure used by kidney specialists to treat children whose kidneys have failed.

Why is dialysis needed in kidney failure?

The main function of the kidneys is to keep the blood clean and remove all the excess water, salts, and chemicals that are not needed or are harmful to the body. These are thrown out of the body through urine. Normally, we have two kidneys to do his work. The kidneys work 24 x 7 and clean the blood 4 to 5 times every hour.

When kidneys are damaged, they cannot clean the blood efficiently. Hence, unwanted water, salt, and bad chemicals accumulate in the blood. This can lead to ill effects on other organs like the blood, heart, lungs, and brain. If this is not recognized and treated in time, it can even lead to death.

How does dialysis help?

Dialysis removes the excess water, salt, and harmful chemicals from the body and keeps the body safe.

How is dialysis done?

Dialysis can be done in two different ways.

1. Hemodialysis is known as HD. “Hemo” means blood. This dialysis is done in hospitals through a special hemodialysis machine. Blood of the patient is pumped through a filter that removes the excess water and chemicals and returns the cleaned blood back to the patient. The dialysis is done for 4 hours three times a week.

2. Peritoneal dialysis or PD is a simpler procedure and quite commonly used in children especially the smaller children. It can be done even in new-born babies. A soft PD catheter or tube is placed inside the child’s abdomen. Dialysis is done like a washout. A measured quantity of special dialysis fluid is run into the abdomen through the catheter and allowed to remain there for a few hours. During this dwell period, impurities from the blood flow into the dialysis fluid. After a few hours, the fluid with the impurities is drained out. The process is then repeated 3 to 4 times in the day. As this is a simple and gentler procedure, it can be easily done by the mother or father at home.

Once dialysis has been started can it be stopped?

This depends on the kind of kidney failure. There are two types of kidney failure.

  1. Acute kidney failure: In this condition, a child who was previously well with no kidney disease suddenly develops kidney failure because of other serious illnesses such as infections like dengue, malaria, leptospirosis, or due to heavy medications, accidents, poisonings, or snake bite. Dialysis may be needed to save the life of the child. Many children recover completely and the dialysis may be stopped after a few days or few weeks.
  2. Chronic kidney failure: This may happen to children who already have a kidney problem which slowly progresses and damages the kidney. In these situations, the kidney cannot recover, and dialysis needs to be continued until the child can get a kidney transplant.

How can the parents suspect that the child’s kidney has failed or is failing?

  1. The easiest sign to recognize is a decrease in the quantity of urine that the child passes. Normally, a child will pass urine 5 to 8 times in the day. If the child is passing less than 5 times it is a cause for concern.
  2. Swelling over the eyelids giving a puffy appearance. This is seen when fluid accumulates in the body.
  3. Loss of appetite, nausea, and vomiting.
  4. Generalized weakness and loss of energy. The child may prefer to sit in one place or lie down and may have no interest in playing.
  5. The child may become anemic and may look pale.
  6. There may be breathing difficulty and cough because of the accumulation of water in the lungs. The child may become breathless on walking or may not be able to lie down flat and maybe comfortable only if propped up with a pillow.
  7. The blood pressure may increase and if this is severe it can cause convulsions and unconsciousness

Dr. Uma Ali, Senior Consultant Nephrology – Paediatric, NH SRCC Children’s Hospital, Mumbai

Narayana Health

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