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The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure

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Abstract

The uremic state impairs compensatory responses to ultrafiltration (UF). Intradialytic symptoms and hypotension can result and lead to premature discontinuation of treatment and sub-optimal dialysis. We report the benefits of mannitol, sequential dialysis and midodrine in reducing dialysis failures in those children prone to intradialytic hypotension. Prophylactic mannitol halved the odds of intradialytic symptoms and hypotension and increased UF volumes. Sequential dialysis halved the odds of symptoms but hypotension persisted. In one patient with refractory hypotension, only intradialytic midodrine consistently maintained acceptable intradialytic blood pressures, reduced intradialytic symptoms and increased the UF potential.

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Authors and Affiliations

  1. Department of Nephro-urology, Great Ormond Street Hospital for Children, London, UK

    Daljit K. Hothi

  2. Division of Nephrology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada

    Daljit K. Hothi, Elizabeth Harvey & Denis Geary

  3. Department of Biostatistics, Hospital for Sick Children, Toronto, Canada

    Cristina M. Goia

  4. Division of Nephrology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada, M5G 1X8

    Denis Geary

Authors
  1. Daljit K. Hothi
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  2. Elizabeth Harvey
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  3. Cristina M. Goia
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  4. Denis Geary
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Corresponding author

Correspondence to Denis Geary.

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Hothi, D.K., Harvey, E., Goia, C.M. et al. The value of sequential dialysis, mannitol and midodrine in managing children prone to dialysis failure. Pediatr Nephrol 24, 1587–1591 (2009). https://doi.org/10.1007/s00467-009-1151-8

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  • DOI: https://doi.org/10.1007/s00467-009-1151-8

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