Abstract
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.
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References
Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105
Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease. J Am Med Assoc 309:1921–1929
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R, Hemodialysis Study Group (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347:2010–2019
Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S, Mexican Nephrology Collaborative Study Group (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13:1307–1320
Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A, Burger MC (2006) Intensified and daily hemodialysis in children might improve statural growth. Pediatr Nephrol 21:1746–1752
Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387
Hoppe A, von Puttkamer C, Linke U, Kahler C, Booss M, Braunauer-Kolberg R, Hofmann K, Joachimsky P, Hirte I, Schley S, Utsch B, Thumfart J, Briese S, Gellermann J, Zimmering M, Querfeld U, Muller D (2011) A hospital-based intermittent nocturnal hemodialysis program for children and adolescents. J Pediatr 158:95–99
Maduell F, Moreso F, Pons M, Ramos R, Mora-Macia J, Carreras J, Soler J, Torres F, Campistol JM, Martinez-Castelao A, Group ES (2013) High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24:487–497
Fischbach M, Dheu C, Seuge L, Menouer S, Terzic J (2008) In-center daily on-line hemodiafiltration: a 4-year experience in children. Clin Nephrol 69:279–284
Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 25:867–873
Pinheiro JC, Bates D (2009) Mixed-Effects Models in S and S-Plus. Statistics and Computing series, 2nd edn. Springer, New York
Pinheiro JC, Bates D, DebRoy S, Deepayan S, R Development Core Team (2013) NLME: linear and nonlinear mixed effects models. R package version 3. pp 1–113
Hothorn T, Bretz F, Westfall P (2008) Simultaneous inference in general parametric models. Biom J 50:346–363
Lacson E Jr, Wang W, Lester K, Ofsthun N, Lazarus JM, Hakim RM (2010) Outcomes associated with in-center nocturnal hemodialysis from a large multicenter program. Clin J Am Soc Nephrol 5:220–226
Lacson E Jr, Xu J, Suri RS, Nesrallah G, Lindsay R, Garg AX, Lester K, Ofsthun N, Lazarus M, Hakim RM (2012) Survival with three-times weekly in-center nocturnal versus conventional hemodialysis. J Am Soc Nephrol 23:687–695
Powe JR, Oluwaseun O, Woo YM, Padmanabhan N, Narasinghan E, Latta C, Tortolano J, Jardine AG, Geddes CC (2009) Ten years experience of in-center thrice weekly long overnight hemodialysis. Clin J Am Soc Nephrol 4:1097–1101
Weinreich T, De los Rios T, Gauly A, Passlick-Deetjen J (2006) Effects of an increase in time vs. frequency on cardiovascular parameters in chronic hemodialysis patients. Clin Nephrol 66:433–439
Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line haemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367
Shroff R, Quinlan C, Mitsnefes M (2011) Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation? Pediatr Nephrol 26:853–865
Shroff R, Weaver DJ Jr, Mitsnefes MM (2011) Cardiovascular complications in children with chronic kidney disease. Nat Rev Nephrol 7:642–649
Mitsnefes MM, Barletta GM, Dresner IG, Chand DH, Geary D, Lin JJ, Patel H (2006) Severe cardiac hypertrophy and long-term dialysis: the Midwest Pediatric Nephrology Consortium Study. Pediatr Nephrol 21:1167–1170
Hothi DK, Harvey E, Piva E, Keating L, Secker D, Geary DF (2006) Calcium and phosphate balance in adolescents on home nocturnal haemodialysis. Pediatr Nephrol 21:835–841
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Thumfart, J., Puttkamer, C.v., Wagner, S. et al. Hemodiafiltration in a pediatric nocturnal dialysis program. Pediatr Nephrol 29, 1411–1416 (2014). https://doi.org/10.1007/s00467-014-2776-9
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DOI: https://doi.org/10.1007/s00467-014-2776-9