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Intensive in-center hemodialysis for children: a case for longer dialysis duration
Lorraine Bell1, Pauline Espinosa
1Montreal Children's Hospital, Department of Pediatrics, Division of Nephrology, Montreal, Quebec, Canada. lorraine.bell@muhc.mcgill.ca
Insights
Optimizing dialysis time in children with renal failure is crucial. Intensive hemodialysis showed excellent growth, nutrition, and mineral control, with reasonable blood pressure, but larger studies are needed.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Cardiovascular Risk Management
Background:
- Children with renal failure require optimized dialysis. Cardiovascular risk factors like hypertension and mineral imbalances are key concerns.
- Previous research indicated catch-up growth in children on long intermittent hemodialysis.
- This study retrospectively analyzed cardiovascular risk factors in pediatric patients on this regimen.
Purpose of the Study:
- To evaluate cardiovascular risk factors in pediatric patients undergoing long intermittent hemodialysis.
- To assess the effectiveness of intensive hemodialysis in managing growth, nutrition, and mineral metabolism.
- To determine the impact of this dialysis regimen on blood pressure control in children.
Main Methods:
- Retrospective chart review of pediatric patients on dialysis between 1997 and 2001, with at least 6 months of treatment.
- Evaluation of calcium (Ca), phosphorus (P), parathyroid hormone (PTH), albumin, hemoglobin, and blood pressure levels.
- Calculation of mean values for biochemical markers and dialysis parameters over 6-month intervals up to 36 months.
Main Results:
- Mean dialysis dose (Kt/V) ranged from 1.9 to 2.1, with weekly dialysis times of 14.8–16.3 hours.
- Excellent control of calcium (Ca) and phosphorus (P) levels was observed (P < 1.8 mM, Ca x P < 4.4 mmol²/L²).
- Mean hemoglobin (115–126 g/L), albumin (39–41 g/L), and PTH (156–231 pg/mL) levels were favorable, with most patients having normal blood pressure.
Conclusions:
- Intensive center hemodialysis in this pediatric cohort was linked to superior growth, nutrition, and mineral and anemia management.
- The regimen demonstrated reasonable blood pressure control in children with renal failure.
- Further large-scale multicenter studies are necessary to establish optimal dialysis strategies for pediatric patients.
Background:
Children with renal failure need their dialysis time optimized. Although traditional surrogate markers of outcome in pediatric patients have been growth and development, increasing attention is being focused on cardiovascular risk factors, such as hypertension, volume overload, malnutrition, and elevated calcium (Ca) and phosphorus (P) levels. We have previously shown catch-up growth without growth hormone, in children undergoing long intermittent hemodialysis. Recently we analyzed retrospectively cardiovascular risk factors in patients treated with this regimen.
Methods:
Patients starting dialysis between 1997 and 2001 and on dialysis at least 6 months were evaluated. Charts were reviewed for Ca, P, parathyroid hormone (PTH), albumin, hemoglobin and blood pressure levels, Ca intake, blood pressure medications, dialysis time, and clearance and ultrafiltration rates. Means were calculated for 6- month intervals, up to 36 months.
Results:
Mean equilibrated dialyzer Kt/V(urea)ranged from 1.9 to 2.1, and mean weekly dialysis time for oliguric patients varied from 14.8 to 16.3 hr, with average hourly ultrafiltration rates from 0.3 to 0.4 L. Mean values for P and Ca x P were below 1.8 mM and 4.4 mmol (2)/L(2), respectively. Mean hemoglobin levels were 115 to 126 g/L, albumin 39 to 41 g/L, and PTH 156 to 231 pg/mL. Most patients had normal predialysis blood pressures.
Conclusions:
In this pediatric cohort, intensive center hemodialysis was associated with excellent growth, nutrition, Ca, P, and anemia control and reasonable blood pressure values. Large multicenter studies are needed to better determine optimal dialysis therapy for children.
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