Growth of children with end-stage renal disease undergoing daily hemodialysis

Abstract

Our data show that the DHD favored a 0.5 SDS height gain in a third of patients without GH treatment. Dialysis intensification was not a cause for treatment dropouts, and DHD should be considered as a treatment for selected cases, especially small children.

Nocturnal home hemodialysis in children: Advantages, implementation, and barriers

“…In an observational study on 24 children undergoing daily hemodialysis (DHD) vs 26 children on conventional HD, nearly one ‐third of patients in the DHD group had an increase in the height of 0.5 SDS as opposed to only one‐tenth patients in the control group with similar results. Also, nearly all the patients in the DHD group had an adequate total caloric intake, whereas only 38% in the CHD group had improvement in dietary intake . Fischbach et al reported an increase in growth velocity from 3.8 ± 1.1 to 14.3 ± 3.8 cm/y during the first year in 15 children receiving in‐center daily online hemodiafiltration along with a resultant change in height SDS over the entire duration of follow‐up from −1.5 ± 0.3 SDS to +0.2 ± 1.1 SDS …”

“…15,20,21 Another major concern in children undergoing chronic hemo- had an adequate total caloric intake, whereas only 38% in the CHD group had improvement in dietary intake. 19 Overall intensified dialysis regimens have noteworthy advantages which need to be validated in larger cohorts of patients so that intensified dialysis programs can become a norm rather than an exception.…”

Nocturnal intermittent hemodialysis

“…Intensified dialysis programs for children and adolescents have been established in very few centers worldwide [37][38][39][40][41][42][43] (Table 2).…”

“…In a second study, the research group showed that SDHD promotes catch-up growth in combination with growth hormone therapy [41], leading these authors to speculate that the improved response to recombinant human growth hormone is the result of less malnutrition and cachexia, De Camargo et al reported on improved growth in children and adolescents on SDHD even without growth hormone therapy. In their prospective, observational study, 33 % of the patients on SDHD showed a 0.5 standard deviation score (SDS) for height gain, whereas only 8 % of the patients on conventional HD achieved the same level [43]. The quality of life in children and adolescents on SDHD is not currently being systematically investigated.…”

Mind the Gap

“…15 To further support the argument for better generalized health with longer treatment time, daily hemodialysis has been associated with improved nutrition and improved growth in children with ESRD. 16 Ikizler argued that the selection of healthier patients to longer treatment time may introduce bias favoring the outcomes of longer treatment time. 17 In the only observational multinational study to date showing higher mortality in patients receiving daily hemodialysis compared with those receiving conventional hemodialysis, the authors speculate that some of the French patients may have been assigned daily hemodialysis as rescue therapy and thus were actually sicker than those who received conventional hemodialysis.…”