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Rapid accelerated hemodialysis in children with end-stage renal disease: a randomized clinical trial

Mohamed Khaled El Hatw1, Fatina Fadel, Ramzy El Baroudy

  • 1Cairo University Children's Hospital, Cairo, Egypt. melhatw@yahoo.com

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|January 29, 2013
PubMed

Insights

Rapid accelerated hemodialysis with recirculation (R-AHD PR) allows for reduced heparin use in pediatric patients undergoing dialysis. However, this method did not improve overall dialysis efficiency compared to standard treatments.

Area of Science:

  • Nephrology
  • Pediatric Dialysis
  • Cardiovascular Engineering

Background:

  • Rapid Accelerated Hemodialysis (R-AHD) is a technique designed to increase blood flow rate (BFR) through partial recirculation.
  • R-AHD PR utilizes two blood pump segments to manage recirculation, aiming to enhance anticoagulation and dialysis efficiency.
  • Pediatric end-stage renal disease patients require effective and safe dialysis strategies, particularly concerning anticoagulation.

Purpose of the Study:

  • To evaluate the effectiveness of R-AHD PR in improving anticoagulation and dialysis efficiency in children with end-stage renal disease.
  • To assess the feasibility of using reduced or no heparin with R-AHD PR.
  • To compare R-AHD PR outcomes with conventional double needle hemodialysis (DNHD).

Main Methods:

  • A two-stage study involving ten pediatric patients with end-stage renal disease.
  • Stage 1: Assessed various R-AHD protocols with different heparin doses, followed by a control period of DNHD.
  • Stage 2: Compared R-AHD PR with DNHD, including protocols with low-dose and no heparin, monitoring blood clotting and urea reduction rates.

Main Results:

  • Blood clots occurred in 4 out of 165 R-AHD sessions but in none of the 28 R-AHD PR sessions.
  • Mean urea reduction rates in Stage 1 were comparable between R-AHD protocols (0.60-0.70) and control DNHD (0.71).
  • In Stage 2, R-AHD PR showed a trend towards lower urea reduction (0.66 ± 0.15) compared to DNHD (0.79 ± 0.18), though not statistically significant (P=0.059).

Conclusions:

  • R-AHD PR enables successful hemodialysis in children using low or no heparin without increasing patient blood flow rate.
  • The R-AHD PR technique did not demonstrate an improvement in dialysis efficiency compared to standard DNHD.
  • R-AHD PR shows promise for reduced anticoagulation in pediatric hemodialysis, warranting further investigation into its efficiency.

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