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Adequacy of Dialysis

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Pediatric Nephrology

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Abstract

“Adequate” dialysis is often defined as a minimum clinically acceptable dose, below which occurs an unacceptable risk of poor outcomes. The term “dialysis adequacy” has been used for several decades primarily based on the measurement of small solute clearance including urea and creatinine and the findings from landmark adult-based clinical trials. Unfortunately, there are limited outcome-based data with respect to pediatric dialysis adequacy. Consequently, adult experience and the associated target clearances have been frequently extrapolated to pediatric patients, even though this point remains a matter of controversy. Small solute clearance represents only one part of the effectiveness of dialysis depuration, which should also include the clearance of larger and/or protein-bound molecules that play an important role in uremic toxicity and are more difficult to remove. Moreover, the dialysis prescription should be adjusted in order to maintain fluid balance and normal blood pressure. The achievement of dialysis adequacy should reflect measures that comprehensively aim to reduce child’s morbidity and mortality and to maximize nutritional status, cardiovascular and bone health, growth, and patient/family health-related quality of life.

In this chapter, we discuss the tools that are available for estimating the dialysis dose delivered to pediatric patients treated with hemodialysis and peritoneal dialysis taking into account the specific metabolic, clinical, and rehabilitative needs related to differences of age, body size, residual renal function, nutritional status, and pubertal development. Formulae to estimate or calculate depuration targets are presented referring to pediatric metrics when available. Pediatric observational data related to dialysis adequacy as well as existing pediatric guidelines and recommendations are also reported.

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Authors and Affiliations

  1. Dialysis Unit, Department of Pediatrics, IRCCS Giannina Gaslini Institute, Genoa, Italy

    Enrico Eugenio Verrina

  2. Division of Nephrology, Department of Pediatrics, British Columbia Children’s Hospital, University of British Columbia, VBC, Canada

    Cherry Mammen

Authors
  1. Enrico Eugenio Verrina
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  2. Cherry Mammen
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Correspondence to Enrico Eugenio Verrina .

Editor information

Editors and Affiliations

  1. Division of Nephrology, Department of Pediatric Specialties, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy

    Francesco Emma

  2. Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein

  3. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Arvind Bagga

  4. Division of Pediatric Nephrology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Carlton M. Bates

  5. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust and University College London Institute of Child Health, London, UK

    Rukshana Shroff

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Verrina, E.E., Mammen, C. (2022). Adequacy of Dialysis. In: Emma, F., Goldstein, S.L., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-52719-8_62

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