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Hemodialysis in children: principles and practice
M Fischbach1, J Terzic, S Menouer
1Nephrology Dialysis Transplantation Children's Unit, Strasbourg, France. Michel.Fishbach@chru-strasbourg.fr
Insights
Recent advancements in hemodialysis technology and clinical management have significantly reduced patient morbidity. Innovations like ultrapure dialysate and online hemodiafiltration offer improved patient outcomes and should be more widely adopted.
Area of Science:
- Nephrology
- Biomedical Engineering
Background:
- Hemodialysis has seen significant technological and clinical advancements in the past decade.
- Patient morbidity during hemodialysis sessions has decreased, with fewer seizures and rare hypotensive episodes or headaches.
Purpose of the Study:
- To review the technological and clinical improvements in hemodialysis over the last decade.
- To highlight the benefits of newer hemodialysis technologies and modalities for patient care.
Main Methods:
- Review of recent technological developments in hemodialysis machines and materials.
- Discussion of advancements in clinical management, including urea kinetic modeling and dialysate quality.
Main Results:
- Significant reduction in hemodialysis-related morbidity, including pain, seizures, and hypotension.
- Development and implementation of advanced technologies such as ultrapure dialysate, online monitoring, and biocompatible membranes.
- Urea kinetic modeling provides an assessment of dialysis dose (Kt/V) and protein intake.
Conclusions:
- Modern hemodialysis offers improved safety and efficacy due to technological progress.
- Online hemodiafiltration presents numerous advantages and should not be restricted to high-risk patients.
Abstract:
Hemodialysis has benefited from major progress over the last decade, improvements in technology and in clinical management. The morbidity over the sessions have decreased, seizures being exceptional, hypotensive episodes or headaches rare and pain related to the fistula puncture is effectively prevented by xylocaine ointment. The development of urea kinetic modeling allows the calculation of the dialysis dose Kt/V, and an indirect assessment of the protein intake. Even if the validity of these parameters are questioned their analyse provides an assessment and therefore is a "good thing." The patient also benefited from the technological revolution. The newer machines provide for precise control of ultrafiltration volumetrically assessed, buffered bicarbonate became a standard technique, biocompatible and highly efficient membranes and specific material available for infants have been developed. More recently the concept of ultrapure dialysate, ie, free of microbiological contamination, germs and endotoxins was developed, as was the availability of continuous blood volume monitoring during the session. The hemodiafiltration modality especially with the on line concept, because of all the advantages, should not be limited only to patients at risk.