The prevalence of insomnia in HD patients is still very high; elderly patients, and those with longer time on dialysis and high levels of PTH are at major risk of insomnia, whereas type of dialysis, haemoglobin levels and behavioural factors do not seem to play a critical role in determining this sleep disorder.
Pediatric PD and HD patients have distinct characteristics. After controlling for treatment-selection biases, children selected to start on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk increases in PD children. What is Known: • Few studies have compared hard outcomes in children on maintenance dialysis. • Children started on different dialysis modalities have distinct characteristics that impact on survival. What is New: • After controlling for treatment-selection biases, children selected to start dialysis on PD or HD exhibit a similar mortality risk during the first 2 years on treatment, after which this risk appears to be increased in PD children. • An "integrative care" approach should be used in children on PD, switching them to HD when PD-related morbidity tends to increase.
Background and Aims
Acute extracorporeal dialysis is a short treatment, performed by a central venous catheter of large size, ensuring high flow. These devices have limitations: high caliber, excessive length, impossibility of tunneling and exit-site location in the supraclavicular region, with a subsequent high risk of dislocation and contamination. The authors report a new approach to dialytic central venous catheters selection in children.
Method
From January 2013 to December 2017, 16 children weighing less than 15 kg needed acute extracorporeal dialysis. Patients received an ultrasound guided percutaneous implantation of a two-way PICC power injectable catheter, in the right internal jugular vein or in the anonymous right vein. The device size always respected the ratio of 1/3; the catheters were cut to be adapted to child height, and subclavear tunnelizations and stabilizations were ensured. The hemodialysis was performed with the Prismaflex Gambro system. The effectiveness of treatment was evaluated by recirculation test and by measuring the KT/Vat the third hour, expressing the dialysis adequacy.
Results
Two-way power injectable central venous catheter,sized from 5 to 7 Fr and long from 8 to 15 cm were used. The recorded blood flow ranged from 4.7ml/min/kg to 7ml/min/kg; a KT/V variable from 0.5 to 1 was detected; the recycling rate was between 32% and 40%. No catheter related complications were observed.
Conclusion
In children weighing less than 15 kg, PICC power injectable have lower blood flow and higher recirculation rate compared to traditional dialysis catheters. However, the dialytic adequacy was suitable for an acute hemodialysis treatment. In addition, these catheters are available in a wide range of calibers and result more adaptable to the venous system of younger children.
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