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Management of Hemodialysis in Children

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Pediatric Kidney Disease

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Abstract

Hemodialysis (HD) was introduced as a treatment for uremia at the end of World War II [1]. A decade later, Mateer et al. reported the first experience using HD to treat five uremic adolescents using 15 meter cellophane tubing and a 32 liter dialysis bath. Each dialysis procedure was 13 h, and although the metabolic and fluid status of their patients improved, there were challenges related to anticoagulation of the circuit and achieving normal plasma calcium and potassium concentrations [2]. Maintenance HD was not practical because vascular access required cannulae placed in the radial artery and saphenous vein prior to each session. This problem was overcome by the development of silastic arteriovenous cannula by Scribner et al [3] which were inserted in the forearm vessels and could be used for repeated blood access. What followed was the report by Fine et al [4] describing the use of HD for maintenance treatment of end-stage kidney disease (ESKD) in five adolescents who were dialyzed three times weekly for 7–8 h per session using a concentrated dialysis solution mixed with tap water. A urea clearance of 45 ml/min resulted in a urea reduction rate (URR) of 48% during each 7–8 h treatment. While maintenance HD was now a realistic option for children with ESKD, technical difficulties persisted in small children and the need for 20 h of treatment per week required long periods of time in the hospital.

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Abbreviations

AAMI:

Association for the Advancement of Medical Instrumentation

ACE:

Angiotensin converting enzyme

ARB:

Angiotensin II receptor antagonists

BMI:

Body mass index

BP:

Blood pressure

BUN:

Blood urea nitrogen

BVM:

The Blood Volume Monitor ™

cIMT:

Carotid intima-media thickness

CKD:

Chronic kidney disease

CRP:

C-reactive protein

DDS:

Dialysis disequilibrium syndrome

DOPPS:

Dialysis Outcomes and Practice Patterns Study

ECV:

Extracellular volume

eKt/V:

Equilibrated Kt/V

ESA:

Erythropoiesis stimulating agent

ESKD:

End-stage kidney disease

G:

Urea generation rate

HD:

hemodialysis

HDF:

Hemodiafiltration

IVC:

Inferior vena cava

IVC:

Intracellular volume

K:

Urea clearance

KDOQI:

National Kidney Foundation Dialysis Outcomes Quality Initiative

KoA:

Mass transfer coefficient of urea

Kuf:

Ultrafiltration coefficient

LAVI:

Left atrial volume indexed to height

L-carnitine:

Levocarnitine

LMWH:

Low molecular weight heparin

LV:

Left ventricular

LVH:

Left ventricular hypertrophy

NCDS:

National Cooperative Dialysis Study

NIVM:

Non-invasive blood volume monitoring

nPCR:

Normalized protein catabolic rate

PTH:

Parathyroid hormone

RBV:

Relative blood volume

spKt/v:

Single pool method

TAC-urea:

Timed-average-concentration of urea

TBV:

Total blood volume

TBW:

Total body water

UF:

Ultrafilter/ultrafiltration

UFH:

Unfractionated heparin

URR:

Urea reduction rate

USRDS:

United States Renal Data System

V:

Volume of distribution unless otherwise specified

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Acknowledgements

We thank Taylor Moatz and Denis Geary for their assistance with the prior versions of this chapter.

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Authors and Affiliations

  1. Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK

    Daljit K. Hothi & Rukshana C. Shroff

  2. Division of Nephrology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Benjamin Laskin

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Correspondence to Daljit K. Hothi .

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  1. Division of Pediatric Nephrology, Heidelberg University, Heidelberg, Germany

    Franz Schaefer

  2. Emory School of Medicine, Emory University, Atlanta, GA, USA

    Larry A. Greenbaum

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Hothi, D.K., Shroff, R.C., Laskin, B. (2023). Management of Hemodialysis in Children. In: Schaefer, F., Greenbaum, L.A. (eds) Pediatric Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-11665-0_66

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