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Hemodiafiltration in a pediatric nocturnal dialysis program

Julia Thumfart1, Christina V Puttkamer, Steffen Wagner

  • 1Department of Pediatric Nephrology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13363, Berlin, Germany.

Pediatric Nephrology (Berlin, Germany)
|February 19, 2014
PubMed

Insights

Nocturnal hemodiafiltration improved pediatric dialysis by enhancing uremia control and nutritional status. This intensified dialysis approach, using hemodialfiltration (NHDF), significantly increased dialysis dose (Kt/V) compared to nocturnal hemodialysis (NHD).

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Dialysis Technology

Background:

  • Conventional dialysis has deleterious consequences.
  • Intensified dialysis programs show promise in children.
  • Further improvements in pediatric dialysis are being explored.

Purpose of the Study:

  • To investigate the efficacy of hemodialfiltration within an established pediatric nocturnal hemodialysis program.
  • To assess improvements over conventional hemodialysis and nocturnal hemodialysis.

Main Methods:

  • Seven pediatric patients transitioned from conventional hemodialysis (HD) to nocturnal hemodialysis (NHD) for 3 months, then to nocturnal online-hemodiafiltration (NHDF) for 3 months, and back to NHD.
  • Evaluated uremia parameters, blood pressure, intradialytic events, protein catabolic rate, albumin, vitamins, and trace elements.
  • Monitored dialysis-related medications and dietary restrictions.

Main Results:

  • Phosphate and intact parathyroid hormone levels decreased with NHD and NHDF.
  • Dialysis dose (Kt/V) increased, with significantly higher values during NHDF compared to NHD.
  • Blood pressure reduced, albumin levels increased (improved nutrition), and protein catabolic rate rose.
  • Dietary restrictions were eliminated for patients on NHD and NHDF.

Conclusions:

  • Nocturnal hemodialysis and hemodiafiltration significantly improved uremia parameters, nutrition, and hemodynamic stability in pediatric patients.
  • Hemodiafiltration further enhanced the established nocturnal hemodialysis program by increasing the dialysis dose (Kt/V).
Abstract

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