Intradialytic hypotension (IDH) is a common adverse event resulting in premature interruption of hemodialysis, and consequently, inadequate fluid and solute removal. IDH occurs in response to the reduction in blood volume during ultrafiltration and subsequent poor compensatory mechanisms due to abnormal cardiac function or autonomic or baroreceptor failure. Pediatric patients are inherently at risk for IDH due to the added difficulty of determining and attaining an accurate dry weight. While frequent blood pressure monitoring, dialysate sodium profiling, ultrafiltration guided blood volume monitoring, dialysate cooling, hemodiafiltration, and intradialytic mannitol and midodrine have been used to prevent IDH, they have not been extensively studied in pediatric population. Lack of large-scale studies on IDH in children makes it difficult to develop evidence based management guidelines. Here we aim to review IDH preventative strategies in the pediatric population and outlay recommendations from the Pediatric Continuous Renal Replacement Therapy (PCRRT) Workgroup. Without strong evidence in the literature, our recommendations from the expert panel reflect expert opinion and serves as a valuable guide.
training consisted of learning all aspects of acute peritoneal dialysis (PD) and especially focused on two useful techniques for low income countries namely on bedside PD catheter insertion and the local production of PD fluids. Results: Upon the return from training, in December 2017, pediatric PD activities have started, remarkably at a very low cost. From January to October 2018, 27 children with AKI mainly due to severe malaria and sepsis were eligible to dialysis. There were 15 boys and 12 girls with the median age of 8 years (4 months-15 years). The main indications of dialysis were uremic toxicity, prolonged anuria (> 4 days) with fluid overload. Despite the low socioeconomic status of parents, almost all children have been dialyzed and 23 recovered efficient diuresis after an average of 8.0 AE4.1 days of PD treatment. We noted that 1/27 patients developped peritonitis that was effectively treated and 3/27 died of complications of comorbidities. Conclusions: This promising experience reveals the importance of South-South cooperation with the support of the Northern partners. The final goal of this program is to extend the training to practitioners in other provinces of the country in order to contribute significantly to the 0by25 objective of the ISN.
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