Skip to main content

Abstract

Renal replacement therapy (RRT) in the paediatric intensive care unit (PICU) has improved over the years, largely resulting from advances in technology. The modality of RRT used in the PICU depends on the clinical setting, dialysis access, availability of equipment, underlying disease and local expertise. Haemodialysis is one of the modalities of acute dialysis, and depending on the child’s illness it might be the modality of choice. The haemodialysis prescription should be tailored to individual needs. We present the principles, main indications, complications and practical approach to the management of a child on conventional haemodialysis or haemodiafiltration in the acute setting.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71:1028–35.

    Article  CAS  Google Scholar 

  2. Sytherland SM, Byrnes JJ, Kothari M, Longhurst CA, Dutta S, Garcia P, Goldstein SL. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol. 2015;10:554–61. https://doi.org/10.2215/CJN.01900214.

    Article  Google Scholar 

  3. Pannu N, Klarenbach S, Wiebe N, et al. Renal Remplacement therapy in patients with acute renal failure: a systematic review. JAMA. 2008;299:793–805.

    Article  CAS  PubMed  Google Scholar 

  4. Gaillot T, Ozanne B, Betremieux P, Tirel O, Ecoffey C. Acute renal replacement therapy in pediatrics. Ann Fr Anesth Reanim. 2013;32(12):e231–6.

    Article  CAS  PubMed  Google Scholar 

  5. Tattersall J, Canaud B, Heimburger O, Pedrini L, Schneditz D, Biesen WV, European Renal Best Practice advisory Board. High-flux or low-flux dialysis: a position statement following publication of the membrane permeability outcome study. Nephrol Dial Transplant. 2010;25(4):1230–2.

    Article  PubMed  Google Scholar 

  6. Fischbach M, Edefonti A, Schroöder C, Watson A, The European Pediatric Dialysis Working Group. Hemodialysis in children: general practical guidelines. Pediatr Nephrol. 2005;20:1054–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fischbach M, Zaloszyc A, Shroff R. Hemodiafiltration in children: an ultrapure complete blood purification. In: Handbook of dialysis therapy E-book (Chapter 75).

    Google Scholar 

  8. Troyanov S, Cardinal J, Geadah D, et al. Solute clearances during continuous venovenous haemofiltration at various ultrafiltration flow rates using Multiflow-100 and HF1000 filters. Nephrol Dial Transplant. 2003;18:961–6.

    Article  PubMed  Google Scholar 

  9. Akaraborworn O. A review in emergency central venous catheterization. Chin J Traumatol. 2017;20(3):137–40.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Schwab SJ, Quarles LD, Middleton JP, et al. Hemodialysis-associated subclavian vein stenosis. Kidney Int. 1988;33:1156–9.

    Article  CAS  PubMed  Google Scholar 

  11. Schillinger F, Schillinger D, Montagnac R, et al. Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant. 1991;6:722–4.

    Article  CAS  PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention. Guidelines for the prevention of intravascular catheter-related infections. MMWR. 2002;51(RR-10):1–26.

    Google Scholar 

  13. National Kidney Foundation. K/DOQI clinical practice guidelines for vascular access, 2000. Am J Kidney Dis. 2001;37(Suppl 1):S137–81.

    Google Scholar 

  14. Calder F, Gogalniceanu P, Shroff R. Paediatric vascular access for haemodialysis – a rough guide. London, UK: Guy’s and St.Thomas NHS Trust & Great Ormond Street Hospitals.

    Google Scholar 

  15. Dunne N. A meta-analysis of sodium profiling techniques and the impact on intradialytic hypotension. Hemodial Int. 2017;21(3):312–22. https://doi.org/10.1111/hdi.12488.

    Article  PubMed  Google Scholar 

  16. Zhou YL, Liu HL, Duan XF, Sun Y, Liu Q. Impact of sodium and ultrafiltration profiling on haemodialysis-related hypotension. Nephrol Dial Transplant. 2006;21(11):3231–7.

    Article  CAS  PubMed  Google Scholar 

  17. Hothi DK, Harvey E, Goia CM, Geary DF. Evaluating methods for improving ultrafiltration in pediatric hemodialysis. Pediatr Nephrol. 2008;23(4):631–8. https://doi.org/10.1007/s00467-007-0716.

    Article  PubMed  Google Scholar 

  18. Hothi DK, Geary DF. Pediatric hemodialysis prescription, Efficacy, and outcome. In: Comprehensive pediatric nephrology (Chapter 57).

    Google Scholar 

  19. Viegas M, Candido C, Felqueiras J, Clemente J, Barros S, Farbota R, Vera F, Matos A, Sousa F. Dialysate bicarbonate variation in maintenance hemodiafiltration patients: impact on serum bicarbonate, intradialytic hypotension and interdialytic weight gain. Hemodial Int. 2017;21(3):385–92.

    Article  PubMed  Google Scholar 

  20. Yamamoto T, Shojl S, Yamakawa T, Wada A, Suzuki K, Iseki K, Tsubakihara Y. Predialysis and postdialysis pH and bicarbonate and risk of all-cause and cardiovascular mortality in long-term hemodialysis patients. Am J Kidney Dis. 2015;66(3):469–78.

    Article  CAS  PubMed  Google Scholar 

  21. Kato A, Kido R, Onishi Y, Kurita N, Fukagawa M, Akizawa T, Fukuhara S. Association of serum bicarbonate with bone fractures in hemodialysis patients: the mineral and bone disorder outcomes study for Japanese CKD stage 5D patients (MBD-5D). Nephron Clin Pract. 2014;128(1–2):79–87.

    Article  CAS  PubMed  Google Scholar 

  22. Penne EL, Visser L, van den Dorpel MA, van der Weerd NC, Mazairac AH, van Jaarsveld BC, Koopman MG, Vos P, Feith GW, Kremer Hovinga TK, van Hamersvelt HW, Wauters IM, Bots ML, Nube MJ, Ter Wee PM, Blankestijn PJ, Grooteman MP. Microbiological quality and quality control of purified water and ultrapure dialysis fluids for online hemodiafiltration in routine clinical practice. Kidney Int. 2009;76(6):665–72.

    Article  CAS  PubMed  Google Scholar 

  23. Gonzalez-Diez B, Cavia M, Torres G, Abalgar P, Camarero V, Muniz P. The effects of 1-year treatment with a haemodiafiltration with on-ine regeneration of ultrafiltrate (HFR) dialysis on biomarkers of oxidative stress in patients with chronic renal failure. Mol Biol Rep. 2012;39(1):629–34.

    Article  CAS  PubMed  Google Scholar 

  24. Praditpornsilpa K, Tiranathanagul K, Susantitaphong P, Katavetin P, Trakarnvanich T, Townamchai N, Kanjanabuch T, Avihingsanon Y, Tungsanga K, Elam-Ong S. Effects of different levels of endotoxin contamination on inflammatory cytokine production by peripheral blood mononuclear cells after high-flux hemodialysis. Blood Purif. 2011;32(2):112–6.

    Article  CAS  PubMed  Google Scholar 

  25. Davenport A. Alternatives to standard unfractionated heparin for pediatric hemodialysis treatments. Pediatr Nephrol. 2012;27(10):1869–79.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lim W, Cook DJ, Crowther MA. Safety and efficacy of low molecular weight heparins for hemodialysis in patients with end-stage renal failure: a meta-analysis of randomized trials. J Am Soc Nephrol. 2004;15(12):3192–206.

    Article  PubMed  Google Scholar 

  27. Lazrak HH, Rene E, Elftouh N, Leblanc M, Lafrance JP. Safety of low-molecular-weight heparin compared to unfractionated heparin in hemodialysis: a systematic review and meta-analysis. BMC Nephrol. 2017;18(1):187.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ishibe S, Peixoto AJ. Methods of assessment of volume status and intercompartmental fluid shifts in hemodialysis patients: implications in clinical practice. Semin Dial. 2004;17(1):37–43.

    Article  PubMed  Google Scholar 

  29. Kouw PM, Kooman JP, Cheriex EC, Olthof CG, de Vries PM, Leunissen KM. Assessment of postdialysis dry weight: a comparison of techniques. J Am Soc Nephrol. 1993;4:98–104.

    PubMed  CAS  Google Scholar 

  30. Nishikimi T, Futoo Y, Tamano K, Takahashi M, Suzuki T, Minami J, et al. Plasma brain natriuretic peptide levels in chronic hemodialysis patients: influence of coronary artery disease. Am J Kidney Dis. 2001;37:1201–8.

    Article  CAS  PubMed  Google Scholar 

  31. Eng CSY, Bhowruth D, Mayes M, Stronach L, Blaauw M, Barber A, Rees L, Shroff RC. Assessing the hydration status of children with chronic kidney disease and on dialysis: a comparison of techniques. Nephrol Dial Transplant. 2017:1–9. https://doi.org/10.1093/ndt/gfx287.

  32. Coulthard MG, Crosier J, Griffiths C, Smith J, Drinnan M, Whitaker M, Beckwith R, Matthews JN, Flecknell P, Lambert HJ. Haemodialysing babies weighing <8kg with Newcastle infant dialysis and ultrafiltration system (Nidus): a comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol. 2014;29(10):1873–81.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Phan V, Clermont MJ, Merouani A, Litalien C, Tucci M, Lambert M, Mitchell G, Jouvet P. Duration of extracorporeal therapy in acute marple syrup urine disease: a kinetic model. Pediatr Nephrol. 2006;21(5):698–704.

    Article  PubMed  Google Scholar 

  34. Rafique M. Emerging trends in management of propionic acidemia. Arg Bras Endocrinol Metabol. 2014;58(3):237–42.

    Article  Google Scholar 

  35. Picca S, Bartuli A, Dionisi-Vici C. Medical management and dialysis therapy for the infant with an inborn error of metabolism. Semin Nephrol. 2008;28(5):477–80.

    Article  CAS  PubMed  Google Scholar 

  36. Mirrakhimov AE, Barbaryan A, Gray A, Ayach T. The role of renal replacement therapy in the management of pharmacologic poisings. Int J Nephrol. 2016;2016:3047329. https://doi.org/10.1155/2016/3047329.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  37. Hayes W, Hothi DK. Intradialytic hypotension. Pediatr Nephrol. 2011;26:867–79.

    Article  PubMed  Google Scholar 

  38. Song JH, Park GH, Lee SY, Lee SW, Kim MJ. Effect of sodium balance and the combination of ultrafiltration profile during sodium profiling hemodialysis on the maintenance of the quality of dialysis and sodium and fluid balances. J Am Soc Nephrol. 2005;16:237–46.

    Article  CAS  PubMed  Google Scholar 

  39. Fischbach M, Terzie J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A. Daily on-line haemofiltration; a pilot trial in children. Nephrol Dial Transplant. 2004;19:2360–7.

    Article  PubMed  Google Scholar 

  40. Hothi DK, Harvey E, Goia C, Geary D. The value of sequential dialysis, mannitol and midodrine in children prone to dialysis failure. Pediatr Nephrol. 2009;24:1587–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rukshana Shroff .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Preka, E., Shroff, R. (2018). Haemodialysis. In: Deep, A., Goldstein, S. (eds) Critical Care Nephrology and Renal Replacement Therapy in Children. Springer, Cham. https://doi.org/10.1007/978-3-319-90281-4_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90281-4_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90280-7

  • Online ISBN: 978-3-319-90281-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics