BACKGROUND: To overcome the deleterious consequences of conventional dialysis, intensified dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, nocturnal hemodialysis program. METHODS: After being started on conventional hemodialysis (HD), seven patients were switched to intermittent nocturnal hemodialysis (NHD) for 3 months, then to intermittent nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. RESULTS: Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. CONCLUSIONS: The introduction of a nocturnal dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
BACKGROUND: To overcome the deleterious consequences of conventional dialysis, intensified dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, nocturnal hemodialysis program. METHODS: After being started on conventional hemodialysis (HD), seven patients were switched to intermittent nocturnal hemodialysis (NHD) for 3 months, then to intermittent nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered. RESULTS:Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF. CONCLUSIONS: The introduction of a nocturnal dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
Authors: Mark M Mitsnefes; Gina M Barletta; Ian G Dresner; Deepa H Chand; Denis Geary; Jen-Jar Lin; Hiren Patel Journal: Pediatr Nephrol Date: 2006-06-29 Impact factor: 3.714
Authors: Daljit K Hothi; Elizabeth Harvey; Elizabeth Piva; Laura Keating; Donna Secker; Denis F Geary Journal: Pediatr Nephrol Date: 2006-04-01 Impact factor: 3.714
Authors: Garabed Eknoyan; Gerald J Beck; Alfred K Cheung; John T Daugirdas; Tom Greene; John W Kusek; Michael Allon; James Bailey; James A Delmez; Thomas A Depner; Johanna T Dwyer; Andrew S Levey; Nathan W Levin; Edgar Milford; Daniel B Ornt; Michael V Rocco; Gerald Schulman; Steve J Schwab; Brendan P Teehan; Robert Toto Journal: N Engl J Med Date: 2002-12-19 Impact factor: 91.245
Authors: Joanna Ruth Powell; Oyeniran Oluwaseun; Yook Mun Woo; Neal Padmanabhan; Eliyanachii Narasinghan; Carol Latta; Julie Tortolano; Alan G Jardine; Colin C Geddes Journal: Clin J Am Soc Nephrol Date: 2009-05-21 Impact factor: 8.237