Abstract
In children conventional hemodialysis does not often improve growth. We determined linear growth in five children on in-center intensified and daily hemodialysis (IDd) regimen, with a mean age of 8 years 7 months at enrolment. Four of five were on growth hormone started for a median of 28.5 months before IDd. IDd was delivered 5 to 6 times weekly, for three hours each session. Mean follow up of IDd was 18.6 months. Dropout from IDd was kidney transplantation (n=4) or transfer to another center (n=1). IDd and free diet improved appetite, thereby protein intake, was above 2 g/kg/BW. Median weekly Kt/Vurea was 9.1 (8.7 to 10.4). Predialysis phosphorus blood levels were higher at the start (2.04±0.34 mmol/L) than at end of IDd (1.39±0.41 mmol/L) without need for carbonate of calcium in four of five cases. During conventional dialysis ht SDS decreased from −0.8 to −1.44, which occurred predominantly before rhGH start. Conversion to IDd significantly increased growth velocity to a mean of 13 cm/year (10.3–18) with a mean change of +1.84 ht SDS/year (0.4 to 2.7). This preliminary report suggests the potential efficacy of IDd regimen in promising growth velocity, either directly from a higher dialysis dose or indirectly through an improved nutritional status.
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References
Neu AM, Bedinger M, Fivush B, Warady B, Watkins S, Friedman A, Brem A, Goldstein S, Frankenfield D (2005) Growth in adolescent hemodialysis patients. Pediatr Nephrol 20:1156–1160
Kaiser BA, Polinsky MS, Stover J, Morgenstern BZ, Baluarte HJ (1994) Growth in children following the initiation of dialysis: a comparison of three modalities. Pediatr Nephrol 8:733–738
Tönshoff B, Fine R (1995) Recombinant human growth hormone for children with renal failure. Adv Ren Replace Ther 3:37–47
Mehls O, Schaefer F, Tönshoff B, Wühl E (2002) Effectiveness of growth hormone treatment in short children with chronic renal failure. J Pediatr 141:147–148
Berard E, Crosnier H, Six Beneton A, Chevallier T, Cochat P, Broyer M (1998) Recombinant human growth hormone treatment in children on hemodialysis. Pediatr Nephrol 12:304–310
Fine RN, Sullivan EK, Tejani A (2000) The impact of recombinant human growth hormone treatment on final adult height. Pediatr Nephrol 14:679–681
Haffner D, Schaefer F, Nessel R, Wühl E, Tönshoff B, Mehls O (2000) German study group for growth hormone treatment in chronic renal failure. Effect of growth hormone treatment on the adult height in children with chronic renal failure. N Engl J Med 28:923–930
Tom A, McCauley L, Bell L, Rodd C, Espinosa P, Yu G, Yu J, Girardin C, Sharma A (1999) Growth during maintenance hemodialysis: Impact of enhanced nutrition and clearance. J Pediatr 134:464–471
Sharme A (2001) Reassessing haemodialysis adequacy in children: the case for more. Pediatr Nephrol 16:381–390
Bell L, Espinosa P (2003) Intensive in center HD for children: a case for longer dialysis duration. Hemodial Int 7:290–295
Locatelli F, Buoncristiani U, Canaud B, Kohler H, Petitclerc T, Zucchelli P (2005) Dialysis dose and frequency. Nephrol Dial Transplant 20:285–296
Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on line hemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367
Groothoff JW (2005) Long term outcomes of children with end stage renal disease. Pediatr Nephrol 20:843–853
Groothoff JW, Lilien MR, Van de Kar NCAJ, Wolff ED, Davin JC (2005) Cardiovascular disease as a late complication of end stage renal disease in children. Pediatr Nephrol 20:374–379
Amann K, Gross ML, London GM, Ritz E (1999) Hyperphosphatemia, a silent killer of patients with renal failure. Nephrol Dial Transplant 14:2085–2087
Achinger SG, Ayus JC (2005) The role of daily dialysis in the control of hyperphosphoremia. Kidney Int 67:S28–32
Fischbach M (1994) Use of hemodiafiltration. Semin Dial 7:409–412
Fischbach M, Edefonti A, Schroeder C, the European Pediatric Dialysis Group (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066
Lebedo I (2001) Does convective dialysis therapy applied daily approach renal blood purification. Kidney Int 78:286–291
Fischbach M, Stefanidis CJ, Watson AR (2002) Guidelines by an ad hoc European Committee on adequacy to pediatric peritoneal dialysis prescription. Nephrol Dial Transplant 17:380–385
Coleman JE, Edefonti A, Watson AR, the European Pediatric Peritoneal Dialysis Working Group (2001) Guidelines on the assessment of growth and nutritional status in children on chronic peritoneal dialysis. Perit Dial Int 21:323–326
Klaus G, Watson A, Edefonti A, Fischbach M, the European Pediatric Dialysis Working Group (2006) Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines. Pediatr Nephrol 21:151–159
Neu AM, Ho PL, McDonald RA, Warady BA (2002) Chronic dialysis in children and adolescent. The 2001 NAPTRCS Annual Report. Pediatr Nephrol 17:656–663
Goldstein SL (2004) Adequacy of dialysis in children: does small solute clearance really matter. Pediatr Nephrol 19:1–5
Goldstein SL, Currier H, Walters L, Hempe JM, Sheth RD, Silverstein D (2003) Acute and chronic inflammation in pediatric patients receiving hemodialysis. J Pediatr 5:653–657
Perriatos A (2004) Daily nocturnal home hemodialysis. Kidney Int 65:1975–1986
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Fischbach, M., Terzic, J., Menouer, S. et al. Intensified and daily hemodialysis in children might improve statural growth. Pediatr Nephrol 21, 1746–1752 (2006). https://doi.org/10.1007/s00467-006-0226-z
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DOI: https://doi.org/10.1007/s00467-006-0226-z