Original ArticleHome nocturnal hemodialysis in children
Section snippets
Patient 1
Patient 1 was a 13-year-old male with end-stage renal disease caused by focal segmental glomerulosclerosis who started PD at age 4 years, and subsequently underwent bilateral nephrectomy and renal transplantation at age 8. At age 11, because of recurrent disease in the graft and chronic allograft nephropathy, he underwent graft nephrectomy and restarted PD. He had recurrent peritonitis and 2 episodes of pancreatitis, which necessitated a switch to HD. On HD, he remained malnourished, had
Methods
The technical considerations, including home renovations, dialysis machines and water purification units, the possible need for water softeners, and the remote monitoring process, were previously reported for our program and for adults.13, 14
Vascular access was provided initially with central venous lines (CVL) in all 4 patients and, subsequently, arteriovenous (AV) fistulae in 2 patients. During NHD, central venous lines are held in place with a locking device described by Pierratos.7 Access
Patient Selection
The 4 families who met eligibility criteria agreed to participate in the program and completed the training requirements. No families have been denied access to this program. Clinical and biochemical outcomes are reported at 3 and 6 months for all patients; 12-month data are available for patients 1 and 2. Patient 1 received NHD for 1 year before switching to a hybrid form of dialysis of NHD Sunday to Wednesday nights inclusive, with an in-center HD on Friday for respite purposes. There have
Discussion
This report describes the successful implementation of NHD for children. Although introduced approximately 10 years ago for adults, the only previous pediatric experience with NHD, published in abstract form from Sweden,12 described 4 children with ages similar to our own patients. They used CVL as blood access, whereas we have also successfully used AV fistulas. Overall, their brief report suggests that outcomes are comparable to our own, and that NHD provides an improvement in patient
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Alternate Hemodialysis Prescriptions in Children
2022, Handbook of Dialysis TherapyChronic dialysis in children and adolescents: challenges and outcomes
2017, The Lancet Child and Adolescent HealthCitation Excerpt :Current paediatric consensus guidelines recommend keeping serum calcium and phosphate in the age-appropriate normal range, but guidelines on parathyroid hormone vary considerably.44,45 Intensified dialysis, either using prolonged overnight haemodialysis sessions or more frequent haemodialysis (particularly haemodiafiltration) considerably improves phosphate clearance.23–26 The effects of using different phosphate binders to reduce phosphate in bone disease32,43 and of native and active vitamin D analogues in the prevention and treatment of CKD-MBD in children has been demonstrated in multiple association studies.43–45
Home Hemodialysis in Children
2017, Handbook of Dialysis Therapy: Fifth EditionOptimal care of the infant, child, and adolescent on dialysis: 2014 update
2014, American Journal of Kidney DiseasesCitation Excerpt :Conventionally, HD has been provided 3 times a week; however, intensified HD for children and adolescents, including short daily HD, intermittent nocturnal HD, and daily nocturnal HD, increasingly is recognized as an important strategy to optimize care.28,43-48 Compared to conventional thrice-weekly HD, intensified programs have demonstrated improved control of phosphate levels, anemia, blood pressure, and fluid status and have provided unique benefits for children and adolescents in terms of improved growth and nutrition.28,47-56 As with PD, the efficiency of HD typically is measured in terms of urea clearance.
Supported by a grant from the CHANGE foundation.