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Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?

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There is a growing interest in the use of daily dialysis since long-term experiences have shown good results. Online hemodiafiltration (OL-HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL-HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL-HDF at least during the last 6 months, were switched to D-OL-HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D-OL-HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D-OL-HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. Is it ethical to reserve this dialysis modality only to selected children?

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1492-7535.2004.0085by.x

Affiliations: Dialysis Children's Unit, Strasbourg, France.

Publication date: January 1, 2004

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