Home nocturnal hemodialysis in children

Geary, Denis F.; Piva, Elizabeth; Tyrrell, Jessica; Gajaria, Mukesh; Picone, Gail; Keating, Laura E.; Harvey, Elizabeth

doi:10.1016/j.jpeds.2005.04.034

Cited by 66 publications

(38 citation statements)

References 20 publications

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

Section: Intensified Dialysis Programs For Children and Adolescentsmentioning

confidence: 99%

“…Geary et al established a NHHD program for children and adolescents in Canada [42]. Patients had no fluid or dietary restriction after switching to NHHD.…”

Section: Intensified Dialysis Programs For Children and Adolescentsmentioning

confidence: 99%

“…Patients had no fluid or dietary restriction after switching to NHHD. Although quality of life was not systematically evaluated, the authors reported that the quality of life and school attendance improved after the patients switched to NHHD [42]. Studies on children and adolescents on NIHD…”

Section: Intensified Dialysis Programs For Children and Adolescentsmentioning

confidence: 99%

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Nocturnal intermittent hemodialysis

Thumfart

Müller

2014

Pediatr Nephrol

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Preemptive renal transplantation is the method of choice for end stage renal disease in childhood and adolescence. However, without preemptive transplantation, waiting time for kidney transplantation might exceed several years. The poor quality of life and the extremely high morbidity and mortality rates of dialysis patients have led to the development of intensified hemodialysis programs in which the modes of dialysis (short daily, nocturnal intermittent or daily nocturnal) are different. Such programs have been shown to significantly improve several uremia-associated parameters, such as blood pressure, phosphate control, anemia and growth retardation, in both adult and pediatric (children and adolescents) patients and lead to a reduction in medications, including phosphate binders, erythropoietin and antihypertensive agents. Fluid limitations and dietary restrictions can also be lifted. With respect to psychosocial rehabilitation and quality of life, nocturnal intermittent dialysis programs provide a reasonable compromise of all forms of intensified programs. Experiences and practical approaches of our own in-center nocturnal intermittent hemodialysis program in the light of the recent publications are described in this review.

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

Section: Intensified Dialysis Programs For Children and Adolescentsmentioning

confidence: 99%

“…Geary et al established a NHHD program for children and adolescents in Canada [42]. Patients had no fluid or dietary restriction after switching to NHHD.…”

Section: Intensified Dialysis Programs For Children and Adolescentsmentioning

confidence: 99%

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Nocturnal intermittent hemodialysis

Thumfart

Müller

2014

Pediatr Nephrol

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“…Tom and colleagues demonstrated improved growth in patients with intensive thrice-weekly HD (approximately 5 h per treatment to yield an spKt/V of 2.0) and a caloric intake at 150% of the recommended daily allowance (RDA) for age [12]. Other more recent investigations have shown improved growth associated with an intensified five or sixtimes-weekly HD treatment regimen [13] and improved biochemical control and health-related quality of life (HRQOL) in patients receiving a six-to seven-times-weekly nocturnal HD treatment regimen [14]. However, the previously published regimens either require increased time in the dialysis center [12,13] or modification of the family's home water supply to provide in-home treatments.…”

Section: Introductionmentioning

confidence: 99%

Frequent hemodialysis with NxStage™ system in pediatric patients receiving maintenance hemodialysis

et al. 2008

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Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38-61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate <1 g/kg per day at the beginning of the study improved to a normalized protein catabolic rate (nPCR) of >1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage system be considered for children who would benefit from home-based maintenance dialysis.

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“…At present there are only three reports of NHD in the paediatric population, with very few details on the factors affecting bone metabolism [7][8][9]. In this article we describe the changes in the biochemical indices of bone metabolism in four children on NHD therapy and the resultant impact on dialysate composition, medical therapy of hyperparathyroidism and net calcium and phosphate balance.…”

Section: Introductionmentioning

confidence: 99%

Calcium and phosphate balance in adolescents on home nocturnal haemodialysis

et al. 2006

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Studies in adults show superior serum phosphate and parathyroid hormone (PTH) control on slow nocturnal haemodialysis (NHD) compared with conventional haemodialysis. We studied the progress of four children aged 12, 13, 14 and 16 years after they had been initiated on NHD. The follow-up period ranged from 6 months to 20 months. Biochemical indices of bone metabolism were collected prospectively. All four children were initially dialysed against a 1.5 mmol/l calcium bath. In two patients, owing to biochemical hypocalcaemic episodes, the dialysate calcium concentration was increased to 1.75 mmol/l. One patient became hypercalcaemic and received calcitonin for bone pain secondary to osteoporosis and was dialysed against a 1.0 mmol/l calcium bath. Including an evaluation of dietary intake, all four patients had a net positive calcium balance, ranging from 5.1 mmol/m2 body surface area (BSA) per day to 24.3 mmol/m2 BSA per day. A significant reduction in the pre-dialysis phosphate level was observed in all four patients, such that none required dietary restrictions or phosphate binders, and dialysate phosphate supplements of 0.8-2.03 mmol/l were employed to prevent hypophosphataemia. The (CaxPO4) dropped below 4.4 mmol(2) l(-2) in all four patients. Concurrently, significant reductions in intact PTH levels were seen in all four patients, but the level dropped to below normal range in two. In our cohort of patients, NHD rapidly lowered plasma phosphate and PTH levels, and additional dialysate phosphate and possibly calcium may be necessary to prevent bone demineralisation due to chronic losses and to prevent oversuppression of PTH.

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Home nocturnal hemodialysis in children

Cited by 66 publications

References 20 publications

Nocturnal intermittent hemodialysis

Nocturnal intermittent hemodialysis

Frequent hemodialysis with NxStage™ system in pediatric patients receiving maintenance hemodialysis

Calcium and phosphate balance in adolescents on home nocturnal haemodialysis

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