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Sequential hypertonic haemodialysis in children
M Fischbach1, E Tarral, J Geisert
1Service de Pediatrie, Hopital de Hautepierre, Strasbourg, France.
Insights
Sequential hypertonic dialysis (SHD) improved circulatory stability in children by removing intracellular water. This study dialysis method also enhanced removal of potassium and phosphate during ultrafiltration.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Renal Replacement Therapy
Background:
- Children with kidney failure often face challenges with fluid management during dialysis.
- Rapid fluid removal can lead to circulatory instability.
- Intracellular fluid shifts are a critical factor in dialysis tolerance.
Purpose of the Study:
- To evaluate the efficacy and safety of Sequential Hypertonic Dialysis (SHD) in binephrectomized children.
- To assess the impact of SHD on fluid balance, electrolyte removal, and circulatory stability.
- To explore SHD as a potential method for improving dialysis tolerance in pediatric patients.
Main Methods:
- A 6-week study involving two binephrectomized children utilizing SHD.
- Dialysis sessions featured alternating periods of high (190 mmol/l) and standard (140 mmol/l) dialysate sodium concentrations.
- Sodium-free water clearance (C(ONa)) was calculated to assess intracellular water removal.
Main Results:
- Positive C(ONa) indicated water removal from both intracellular and extracellular compartments.
- SHD improved circulatory stability during ultrafiltration, facilitating fluid removal.
- Increased removal of potassium and phosphate was observed.
- A trend towards positive sodium balance and potential cardiovascular morbidity was noted.
Conclusions:
- SHD effectively stabilizes blood volume during ultrafiltration in pediatric patients.
- The method enhances the removal of uremic toxins by improving fluid management.
- SHD, at the studied dialysate sodium levels, is a promising but investigational dialysis technique for children.
Abstract:
Sequential hypertonic dialysis (SHD) was studied in two binephrectomized children over a period of 6 weeks. Each dialysis session comprised four periods of 45 min. The concentration of sodium in the dialysate [Na(D)] during the first period was 190 mmol/l and during the second period 140 mmol/l. The sequence was then repeated. The sodium-free water clearance [C(ONa)] was calculated from the measurements of the ultrafiltrate clearance and of the sodium clearance. Despite the short periods of hypertonic dialysis, C(ONa) was positive, suggesting that water was removed from the intracellular compartment as well as from the extracellular fluid. The transfer of fluid from the intracellular space improved circulatory stability during rapid removal of large volumes of fluid by ultrafiltration. SHD was also associated with increased removal of potassium and phosphate. Comparison of clinical parameters before and during SHD showed a tendency towards increased sodium balance and the possibility of raised cardiovascular morbidity. SHD stabilized blood volume during ultrafiltration, encouraging removal of uraemic toxins. SHD with this level of Na(D) is only a study dialysis method.