Related Experiment Videos
[Survey on the practice of extrarenal hemofiltration in pediatrics]
J B Gouyon1, P Cochat, C Houzel
1Service de pédiatrie 2, hôpital d'enfants, Dijon, France.
Insights
Pediatric dialysis choices depend on patient age and underlying conditions. Peritoneal dialysis is preferred for younger children, while other methods suit older children, with no deaths directly linked to dialysis techniques.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Context:
- Dialysis is a critical intervention for children with acute kidney injury or other conditions requiring renal support.
- Treatment decisions for pediatric dialysis are complex, influenced by patient-specific factors and available resources.
Purpose:
- To analyze the factors influencing the choice of dialysis modality in pediatric patients.
- To evaluate the utilization of different dialysis methods across various pediatric diseases and age groups.
Summary:
- A study of 126 children in French intensive care units revealed age and underlying disease as key determinants for dialysis method selection.
- Peritoneal dialysis (PD) was favored for children under 10, particularly those with hemolytic-uremic syndrome (HUS) and metabolic diseases.
- Intermittent hemodialysis (IHD), hemofiltration (HF), and hemodiafiltration (HDF) were more common in older children and those with acute liver disease or shock. Overall mortality was 40%, with no direct attribution to dialysis methods.
Impact:
- Provides insights into current pediatric dialysis practices and informs clinical decision-making.
- Highlights the need for further research to optimize indications and evaluate outcomes for various pediatric dialysis techniques.
Background:
Several methods of dialysis are currently available. The choice of whether to use one of them is determined by multiple factors that are analyzed in this study.
Patients And Methods:
One hundred and twenty-six children (mean age: 48 +/- 6 months) were treated in 29 French intensive care units and/or departments of nephrology during 1991. The underlying diseases were: hemolytic-uremic syndrome (HUS) in 28% of patients, other renal diseases in 6%, metabolic diseases in 8%, septic shock in 8%, cardiogenic shock in 9%, hypovolemic shock in 10%, multiple organ failure in 7%, acute liver disease in 9% and other diseases in 15%.
Results:
Peritoneal dialysis (PD) was the favorite method in patients less than 10 years: intermittent hemodialysis (IHD), continuous hemofiltration and hemodiafiltration, (HF, HDF) were preferentially used above this age. PD was used in 85% of HUS, 58% of shocks and 50% of metabolic diseases. Sixty percent of acute renal diseases other than HUS were treated by IHD. HF and HDF were used in 66% of acute liver diseases and 42% of shocks. Overall mortality was 40% but no death could be directly ascribed to the different methods of dialysis.
Conclusion:
The choice of method depends on the type of underlying disease, age of the patient but also the equipment of centers. Progress in evaluating indications and results of the different methods of dialysis are necessary.