Abstract
Background
From 2006 to 2020, 24% of children starting haemodialysis in France weighed < 20 kg. Most new-generation long-term haemodialysis machines do not propose paediatric lines anymore but Fresenius has validated two devices for use in children above 10 kg. Our aim was to compare the daily use of these two devices in children < 20 kg.
Methods
Retrospective single-center evaluation of daily practice with Fresenius 6008® machines, and low-volume paediatric sets (83 mL), as compared to 5008® machines with paediatric lines (108 mL). Each child was treated randomly with both generators.
Results
A total of 102 online haemodiafiltration sessions were performed over 4 weeks in five children (median body weight 12.0 [range 11.5–17.0] kg). Arterial aspiration and venous pressures were maintained respectively over − 200 mmHg and under 200 mmHg. For all children, blood flow and volume treated per session were lower with 6008® vs. 5008® (p < 0.001), median difference between the two devices being 21%. In the four children treated in post-dilution mode, substituted volume was lower with 6008® (p < 0.001, median difference: 21%). Effective dialysis time was not different between the two generators; however, the difference between total duration of session and dialysis effective time was slightly higher (p < 0.05) with 6008® for three patients, due to treatment interruptions.
Conclusion
These results suggest that children between 11 and 17 kg should be treated with paediatric lines on 5008® if possible. They advocate for modification of the 6008 paediatric set to decrease resistance to blood flow. The possibility to use 6008® with paediatric lines in children below 10 kg deserves further studies.
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References
Fischbach M, Edefonti A, Schröder C, Watson A, European Pediatric Dialysis Working Group (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066. https://doi.org/10.1007/s00467-005-1876-y2
Moore J, Klowak J, Isaza G, Arora S, Belostotsky V, Stein N, Chanchlani R (2020) Anterior ischemic optic neuropathy in a child receiving chronic hemodialysis. Case Rep Nephrol 2020:7012586. https://doi.org/10.1155/2020/7012586
Harshman LA, Hooper SR (2020) The brain in pediatric chronic kidney disease-the intersection of cognition, neuroimaging, and clinical biomarkers. Pediatr Nephrol 35:2221–2229. https://doi.org/10.1007/s00467-019-04417-1
Idrovo A, Pignatelli R, Loar R, Nieuwsma A, Geer J, Solomon C, Swartz S, Ghanayem N, Akcan-Arikan A, Srivaths P (2021) Preserved cerebral oxygenation with worsening global myocardial strain during pediatric chronic hemodialysis. J Am Soc Nephrol 32:2912–2919. https://doi.org/10.1681/ASN.2021020193
Hothi DK, Rees L, Marek J, Burton J, McIntyre CW (2009) Pediatric myocardial stunning underscores the cardiac toxicity of conventional hemodialysis treatments. Clin J Am Soc Nephrol 4:790–797. https://doi.org/10.2215/CJN.05921108
Crosier J, Whitaker M, Lambert HJ, Wellman P, Nyman A, Coulthard MG (2022) In vitro measurements of ultrafiltration precision in hemofiltration and hemodialysis devices used in infants. Pediatr Nephrol 37:3189–3194. https://doi.org/10.1007/s00467-022-05439-y
Peters SA, Bots ML, Canaud B, Davenport A, Grooteman MPC, Kircelli F, Locatelli F, Maduell F, Morena M, Nubé MJ, Ok E, Torres F, Woodward M, Blankestijn PJ, HDF Pooling Project Investigators (2016) Haemodiafiltration and mortality in end-stage kidney disease patients: a pooled individual participant data analysis from four randomized controlled trials. Nephrol Dial Transplant 31:978–984. https://doi.org/10.1093/ndt/gfv349
Kikuchi K, Hamano T, Wada A, Nakai S, Masakane I (2019) Predilution online hemodiafiltration is associated with improved survival compared with hemodialysis. Kidney Int 95:929–938. https://doi.org/10.1016/j.kint.2018.10.036
Sagova M, Wojke R, Maierhofer A, Gross M, Canaud B, Gauly A (2019) Automated individualization of dialysate sodium concentration reduces intradialytic plasma sodium changes in hemodialysis. Artif Organs 43:1002–1013. https://doi.org/10.1111/aor.13463
Ranchin B, Schmitt CP, Warady B, Craig JC, Licht C, Hataya H, Vidal E, Vande Walle J, Shroff R (2023) Devices for long-term hemodialysis in small children – a plea for action. Kidney Int. https://doi.org/10.1016/j.kint.2023.03.018
Acknowledgements
The authors thank Pr Rukshana Shroff and Mrs Lynsey Stronach, Great Ormond Street Hospital, London (UK), for sharing their experience on the use of 6008 devices and to Dr Mathilde Lassalle from the Réseau Epidemiologique et Information en Néphrologie (REIN) registry for data extraction.
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Mosca, M., Kouajip-Mabou, A., De Mul, A. et al. Daily practice evaluation of the paediatric set of a next-generation long-term haemodialysis machine. Pediatr Nephrol 38, 3863–3866 (2023). https://doi.org/10.1007/s00467-023-05943-9
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DOI: https://doi.org/10.1007/s00467-023-05943-9