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Sequential hypertonic haemodialysis in children.

M Fischbach1, E Tarral, J Geisert

  • 1Service de Pediatrie, Hopital de Hautepierre, Strasbourg, France.

Pediatric Nephrology (Berlin, Germany)
|October 1, 1988
PubMed
Summary
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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.

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  • 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.