End-stage kidney disease in infancy: an educational review

Pediatr Nephrol. 2020 Feb;35(2):229-240. doi: 10.1007/s00467-018-4151-8. Epub 2018 Nov 21.


An increasing number of infants with end-stage kidney disease (ESKD) are surviving and receiving renal replacement therapy (RRT). Unique clinical issues specific to this age group of patients influence their short- and long-term outcomes. This review summarizes current epidemiology, clinical characteristics, ethical dilemmas, management concerns, and outcomes of infants requiring chronic dialysis therapy. Optimal care during infancy requires a multidisciplinary team working closely with the patient's family. Nutritional management, infection prevention, and attention to cardiovascular status are important treatment targets. Although mortality rates remain higher among infants on dialysis compared to older pediatric dialysis patients, outcomes have improved over time. Most importantly, infants who subsequently receive a kidney transplant are now experiencing graft survival rates that are comparable to older pediatric patients.

Keywords: Chronic hemodialysis; Chronic peritoneal dialysis; Growth; Hemodialysis; Infants; Neonates; Nutrition; Pediatric ESKD; Peritoneal dialysis.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic* / epidemiology
  • Kidney Failure, Chronic* / physiopathology
  • Kidney Failure, Chronic* / therapy
  • Male
  • Renal Dialysis / adverse effects
  • Renal Dialysis / methods