Evaluating methods for improving ultrafiltration in pediatric hemodialysis.

Adequate ultrafiltration (UF) is necessary for good health, but it can be hindered by the development of intradialytic symptoms and hypotension. To determine whether sodium ramping, UF profiles and mannitol could improve UF in children, we instituted a standardized prescription for chronic hemodialysis in our unit. We prospectively analyzed 506 treatments from ten patients. Ultrafiltration volumes up to 9.7% of dry weight were obtained with an overall mean of 5.4%. Mannitol reduced the risk of intradialytic symptoms by 64% (p < 0.05) with a mean UF volume of 6.2%. Step sodium ramping from 148-138 mmol/l reduced the odds of intradialytic symptoms (p = 0.1) and hypotension (p < 0.05) with no difference in the mean UF compared with linear profiles. All UF profiles were associated with an increased risk of intradialytic symptoms, but the effect was only statistically significant with profile 2 (stepwise UF reduction). Overall intradialytic morbidity occurred in 10% of the treatments. Notwithstanding the study limitations, UF volumes higher than traditional recommendations of 5% of the dry weight were achieved with the use of mannitol and 148-138 mmol/l sodium ramping. Despite this, the desired dry weight was not achieved in 66% of our treatments. No clear benefit was seen with UF profiles.