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Intensified and daily hemodialysis in children might improve statural growth

Michel Fischbach1, Joëlle Terzic, Soraya Menouer

  • 1Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, Avenue Molière, 67098, Strasbourg, France. Michel.Fischbach@chru-strasbourg.fr

Pediatric Nephrology (Berlin, Germany)
|August 31, 2006
PubMed

Insights

Intensified and daily hemodialysis (IDd) significantly improved growth velocity in children, increasing height by a mean of 13 cm/year. This regimen also enhanced nutritional status and phosphorus control.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Growth and Development

Background:

  • Conventional hemodialysis often fails to promote adequate linear growth in pediatric patients.
  • Growth hormone therapy is frequently initiated in children with chronic kidney disease, but growth may remain suboptimal.

Purpose of the Study:

  • To evaluate the impact of an intensified and daily hemodialysis (IDd) regimen on linear growth in children.
  • To assess changes in nutritional status and biochemical parameters with IDd.

Main Methods:

  • A cohort of five children (mean age 8 years 7 months) on IDd (5-6 times/week, 3 hours/session) was studied.
  • Four patients were receiving growth hormone therapy prior to IDd initiation.
  • Follow-up averaged 18.6 months, with assessments of growth velocity, nutritional intake, and biochemical markers.

Main Results:

  • IDd, combined with a free diet, led to improved appetite and protein intake (>2 g/kg/BW).
  • Median weekly Kt/V(urea) was high at 9.1, and predialysis phosphorus levels decreased significantly (2.04 to 1.39 mmol/L).
  • Conversion to IDd resulted in a significant increase in growth velocity to a mean of 13 cm/year (+1.84 height SDS/year), contrasting with a decrease in height SDS during prior conventional dialysis.

Conclusions:

  • The intensified and daily hemodialysis (IDd) regimen shows potential efficacy in improving growth velocity in children with chronic kidney disease.
  • Enhanced dialysis dose and improved nutritional status appear to be key factors contributing to accelerated growth.
  • IDd may offer a viable strategy to optimize growth outcomes in this vulnerable population.

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