DALLAS — After an infant developed cyanosis and bradycardia during hemodialysis, researchers concluded that currently available dialysis machines may not be well-suited for small children and may result in unintended adverse effects, according to a case study presented at the Annual Dialysis Conference.
“Unfortunately, we have many children that are on hemodialysis, but we don’t have great machinery to do it,” Kumail Merchant, MD, pediatric nephrology fellow at Cohen Children’s Medical Center in New York, told Healio/Nephrology. “The machines that we have are primarily designed for adults and so, we end up using those adult machines with modifications to work on children. We then end up with unintended consequences.”
After a severe episode of pseudomonas peritonitis, a 5-month-old patient with ESRD and posterior urethral valves was switched from PD to hemodialysis and he then presented with cyanosis and bradycardia during the first ambulatory hemodialysis treatment, according to the poster presentation.
Researchers considered a variety of diagnoses, including arrhythmias, infection and hypovolemia.
Dialysis nurses noticed the patient’s weight was lower after hemodialysis than before treatment (4.24 kg vs. 4.39 kg), which researchers hypothesized was due to unmeasured fluid removal by the dialysis machine. After fluid was administered to the patient during hemodialysis, no further episodes were observed.
“Children can present quickly and so impressively with these tiny little changes that end up being serious, though in adults you wouldn’t think that they would cause these sorts of effects,” Merchant said. “A lot of places probably have children that are this size and that are on dialysis, but the adverse effects haven’t yet been described well in literature. We need better machines and information to dialyze the pediatric population.” – by Melissa J. Webb
Merchant K, et al. The curious case of blue bradycardic baby. Presented at the Annual Dialysis Conference; March 16-19, 2018; Dallas.
Disclosures: Merchant reports no relevant financial disclosures.