Intensified and daily hemodialysis in children might improve statural growth

Abstract

In children conventional hemodialysis does not often improve growth. We determined linear growth in five children on in-center intensified and daily hemodialysis (IDd) regimen, with a mean age of 8 years 7 months at enrollment. Four of five were on growth hormone started for a median of 28.5 months before IDd. IDd was delivered 5 to 6 times weekly, for three hours each session. Mean follow up of IDd was 18.6 months. Dropout from IDd was kidney transplantation (n=4) or transfer to another center (n=1). IDd and free diet improved appetite, thereby protein intake, was above 2 g/kg/BW. Median weekly Kt/V(urea) was 9.1 (8.7 to 10.4). Predialysis phosphorus blood levels were higher at the start (2.04+/-0.34 mmol/L) than at end of IDd (1.39+/-0.41 mmol/L) without need for carbonate of calcium in four of five cases. During conventional dialysis ht SDS decreased from -0.8 to -1.44, which occurred predominantly before rhGH start. Conversion to IDd significantly increased growth velocity to a mean of 13 cm/year (10.3-18) with a mean change of +1.84 ht SDS/year (0.4 to 2.7). This preliminary report suggests the potential efficacy of IDd regimen in promising growth velocity, either directly from a higher dialysis dose or indirectly through an improved nutritional status.

Intensified hemodialysis regimens: neglected treatment options for children and adolescents

“…A daily in-center program for short daily dialysis has been established in Strasbourg, France [15]. Preliminary data of these programs indicate that unique benefits in children might also include better nutritional status and growth, the latter being one of the crucial problems in pediatric nephrology [56]. Alternatively, long nocturnal hemodialysis provides an attractive method, as children and adolescents can go to school or start other activities during the day.…”

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

“…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.…”

Recent advances in pediatric dialysis: a review of selected articles

“…Appropriate minimal and optimal targets for outcome measures for children on dialysis, such as dialysis adequacy and hemoglobin (Hb), remain undefined in children but continue to be addressed [1][2][3]. Growth failure in chronic dialysis patients is often resistant to conventional treatment, including growth hormone (GH), but better information is now being disseminated [4,5].…”