Sequential hypertonic haemodialysis in children

Fischbach, Michel; Tarral, E.; Geisert, J

doi:10.1007/bf00853439

Cited by 20 publications

(22 citation statements)

References 12 publications

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“…No relationship could be established between serum phosphate levels during or post dialysis and baseline PTH values used as a marker of low, normal, or high turnover bone disease, or the rate of PTH suppression during dialysis. The PDPR noted in our study cannot be fully explained by a clinical intracellular extracellular twopool model [13]; however, a rapid and time-dependent influx of phosphate into the extracellular compartment could possibly explain the PDPR, influx resulting from phosphate production by biochemical reactions [5], from cellular wash out [12], or from a bone compartment outflow. The correlation established in our study for serum levels of urea and phosphate between 45 min into dialysis and 30 min post dialysis suggests that similar factors may explain the rebound and the RR during these periods for urea and phosphate.…”

Section: Discussionmentioning

confidence: 88%

“…Urea decreased continuously over the dialysis period, suggesting kinetics which best match a twopool urea kinetics model [10,11]. In contrast, after an initial decrease the serum phosphate levels either stabilized or increased slightly [6], despite persistent dialytic phosphate removal [5,12]. Most of the PRR was achieved after 45 min of dialysis ( Fig.…”

Section: Discussionmentioning

confidence: 99%

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Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Fischbach¹,

Boudailliez²,

Foulard³

1997

Pediatric Nephrology

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Despite low end dialysis serum phosphate levels (Pe) the control of phosphate retention remains often unsatisfactory in dialyzed patients. In order to assess the value of Pe in dialyzed children as an indicator of dialytic phosphate removal, we studied serum phosphate kinetics over the period of dialysis and post dialysis and compared these with urea kinetics. A multicenter study was conducted in the 21 French pediatric hemodialysis units and included 144 children under 15 years of age. Blood urea and phosphate concentrations were measured at the beginning, at 45 min later, at the end of dialysis, and 30 min post dialysis. At 60 min and at 360 min post dialysis measurements were made only for a subgroup of 12 children. From the serum levels, reduction ratios for urea (URR) and phosphate (PRR) and post dialysis rebound for urea (PDUR) and phosphate (PDPR) were calculated. URR (over the dialysis session, 72% +/- 9%) was higher than PRR (47% +/- 12%). Moreover, urea removal continued throughout the dialysis period, while most of the reduction in phosphate occurred in the initial dialysis period. Post dialysis urea rebound was limited to the 60th min post dialysis, whereas post dialysis phosphate rebound occurred until the 360th min post dialysis; by this time the serum phosphate levels had almost reached the predialysis levels. In summary, serum phosphate kinetics over dialysis and post dialysis periods in children appear to be misleading for the quantification of phosphate removal, i.e., phosphate clearance is a poor indicator of dialytic phosphate removal.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Fischbach¹,

Boudailliez²,

Foulard³

1997

Pediatric Nephrology

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“…Sodium concentrations have increased from the previous classical level of 132 mmol L −1 to a more physiological level of 138 to 144 mmol L −1 . Newer machine capabilities enable dialysate profiles to change during a dialysis with respect to sodium and ultrafiltrate profiles [47, 48] to increase tolerated weight loss; and bicarbonate profiles [49], to enhance phosphate removal. Intermittent ultrafiltration rates, enabling better plasma refilling is the most common profile used.…”

Section: Guideline 8: the Dialysatementioning

confidence: 99%

Hemodialysis in children: general practical guidelines

Fischbach¹,

et al. 2005

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Over the past 20 years children have benefited from major improvements in both technology and clinical management of dialysis. Morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Noninvasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs. The development of urea kinetic modeling enables calculation of the dialysis dose delivery, Kt/V, and an indirect assessment of the intake. Nutritional assessment and support are of major importance for the growing child. Even if the validity of these "urea only" data is questioned, their analysis provides information useful for follow-up. Newer machines provide more precise control of ultrafiltration by volumetric assessment and continuous blood volume monitoring during dialysis sessions. Buffered bicarbonate solutions are now standard and more biocompatible synthetic membranes and specific small size material dialyzers and tubing have been developed for young infants. More recently, the concept of "ultrapure" dialysate, i.e. free from microbiological contamination and endotoxins, has developed. This will enable the use of hemodiafiltration, especially with the on-line option, which has many theoretical advantages and should be considered in the case of maximum/optimum dialysis need. Although the optimum dialysis dose requirement for children remains uncertain, reports of longer duration and/or daily dialysis show they are more effective for phosphate control than conventional hemodialysis and should be considered at least for some high-risk patients with cardiovascular impairment. In children hemodialysis has to be individualized and viewed as an "integrated therapy" considering their longterm exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning. In long term chronic dialysis, however, the highest standards should be applied to these children to preserve their future "cardiovascular life" which might include more dialysis time and on-line hemodiafiltration with synthetic high flux membranes if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.

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“…One aspect of this is ultrafiltration (UF), although the ability to remove desired target volumes can be hindered by the development of intradialytic symptoms and hypotension [3]. There are reports of improved hemodynamic stability with the use of UF profiles, either alone [4] or in combination with sodium profiles [5][6][7], and improved UF with sequential hypertonic HD [8]. However, there are few data evaluating recent dialysis technical advances in children [9][10][11], and only one that evaluates UF profiles [12].…”

Section: Introductionmentioning

confidence: 98%

Evaluating methods for improving ultrafiltration in pediatric hemodialysis

et al. 2008

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Adequate ultrafiltration (UF) is necessary for good health, but it can be hindered by the development of intradialytic symptoms and hypotension. To determine whether sodium ramping, UF profiles and mannitol could improve UF in children, we instituted a standardized prescription for chronic hemodialysis in our unit. We prospectively analyzed 506 treatments from ten patients. Ultrafiltration volumes up to 9.7% of dry weight were obtained with an overall mean of 5.4%. Mannitol reduced the risk of intradialytic symptoms by 64% (p < 0.05) with a mean UF volume of 6.2%. Step sodium ramping from 148-138 mmol/l reduced the odds of intradialytic symptoms (p = 0.1) and hypotension (p < 0.05) with no difference in the mean UF compared with linear profiles. All UF profiles were associated with an increased risk of intradialytic symptoms, but the effect was only statistically significant with profile 2 (stepwise UF reduction). Overall intradialytic morbidity occurred in 10% of the treatments. Notwithstanding the study limitations, UF volumes higher than traditional recommendations of 5% of the dry weight were achieved with the use of mannitol and 148-138 mmol/l sodium ramping. Despite this, the desired dry weight was not achieved in 66% of our treatments. No clear benefit was seen with UF profiles.

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Sequential hypertonic haemodialysis in children

Cited by 20 publications

References 12 publications

Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Phosphate end dialysis value : a misleading parameter of hemodialysis efficiency

Hemodialysis in children: general practical guidelines

Evaluating methods for improving ultrafiltration in pediatric hemodialysis

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