Skip to main content

Advertisement

SpringerLink
Log in

Hemodiafiltration in a pediatric nocturnal dialysis program

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

To overcome the deleterious consequences of conventional dialysis, intensified dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, nocturnal hemodialysis program.

Methods

After being started on conventional hemodialysis (HD), seven patients were switched to intermittent nocturnal hemodialysis (NHD) for 3 months, then to intermittent nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered.

Results

Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF.

Conclusions

The introduction of a nocturnal dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

    Article  PubMed  Google Scholar 

  2. Mitsnefes MM, Laskin BL, Dahhou M, Zhang X, Foster BJ (2013) Mortality risk among children initially treated with dialysis for end-stage kidney disease. J Am Med Assoc 309:1921–1929

    Article  CAS  Google Scholar 

  3. Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R, Hemodialysis Study Group (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347:2010–2019

    Article  PubMed  Google Scholar 

  4. Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S, Mexican Nephrology Collaborative Study Group (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13:1307–1320

    CAS  PubMed  Google Scholar 

  5. Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A, Burger MC (2006) Intensified and daily hemodialysis in children might improve statural growth. Pediatr Nephrol 21:1746–1752

    Article  PubMed  Google Scholar 

  6. Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387

    Article  PubMed  Google Scholar 

  7. Hoppe A, von Puttkamer C, Linke U, Kahler C, Booss M, Braunauer-Kolberg R, Hofmann K, Joachimsky P, Hirte I, Schley S, Utsch B, Thumfart J, Briese S, Gellermann J, Zimmering M, Querfeld U, Muller D (2011) A hospital-based intermittent nocturnal hemodialysis program for children and adolescents. J Pediatr 158:95–99

    Article  PubMed  Google Scholar 

  8. Maduell F, Moreso F, Pons M, Ramos R, Mora-Macia J, Carreras J, Soler J, Torres F, Campistol JM, Martinez-Castelao A, Group ES (2013) High-efficiency postdilution online hemodiafiltration reduces all-cause mortality in hemodialysis patients. J Am Soc Nephrol 24:487–497

    Article  PubMed Central  PubMed  Google Scholar 

  9. Fischbach M, Dheu C, Seuge L, Menouer S, Terzic J (2008) In-center daily on-line hemodiafiltration: a 4-year experience in children. Clin Nephrol 69:279–284

    Article  CAS  PubMed  Google Scholar 

  10. Fischbach M, Terzic J, Menouer S, Dheu C, Seuge L, Zalosczic A (2010) Daily on line haemodiafiltration promotes catch-up growth in children on chronic dialysis. Nephrol Dial Transplant 25:867–873

    Article  CAS  PubMed  Google Scholar 

  11. Pinheiro JC, Bates D (2009) Mixed-Effects Models in S and S-Plus. Statistics and Computing series, 2nd edn. Springer, New York

  12. Pinheiro JC, Bates D, DebRoy S, Deepayan S, R Development Core Team (2013) NLME: linear and nonlinear mixed effects models. R package version 3. pp 1–113

  13. Hothorn T, Bretz F, Westfall P (2008) Simultaneous inference in general parametric models. Biom J 50:346–363

    Article  PubMed  Google Scholar 

  14. Lacson E Jr, Wang W, Lester K, Ofsthun N, Lazarus JM, Hakim RM (2010) Outcomes associated with in-center nocturnal hemodialysis from a large multicenter program. Clin J Am Soc Nephrol 5:220–226

    Article  PubMed Central  PubMed  Google Scholar 

  15. Lacson E Jr, Xu J, Suri RS, Nesrallah G, Lindsay R, Garg AX, Lester K, Ofsthun N, Lazarus M, Hakim RM (2012) Survival with three-times weekly in-center nocturnal versus conventional hemodialysis. J Am Soc Nephrol 23:687–695

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Powe JR, Oluwaseun O, Woo YM, Padmanabhan N, Narasinghan E, Latta C, Tortolano J, Jardine AG, Geddes CC (2009) Ten years experience of in-center thrice weekly long overnight hemodialysis. Clin J Am Soc Nephrol 4:1097–1101

    Article  Google Scholar 

  17. Weinreich T, De los Rios T, Gauly A, Passlick-Deetjen J (2006) Effects of an increase in time vs. frequency on cardiovascular parameters in chronic hemodialysis patients. Clin Nephrol 66:433–439

    Article  CAS  PubMed  Google Scholar 

  18. Fischbach M, Terzic J, Laugel V, Dheu C, Menouer S, Helms P, Livolsi A (2004) Daily on-line haemodiafiltration: a pilot trial in children. Nephrol Dial Transplant 19:2360–2367

    Article  PubMed  Google Scholar 

  19. Shroff R, Quinlan C, Mitsnefes M (2011) Uraemic vasculopathy in children with chronic kidney disease: prevention or damage limitation? Pediatr Nephrol 26:853–865

    Article  PubMed  Google Scholar 

  20. Shroff R, Weaver DJ Jr, Mitsnefes MM (2011) Cardiovascular complications in children with chronic kidney disease. Nat Rev Nephrol 7:642–649

    Article  CAS  PubMed  Google Scholar 

  21. Mitsnefes MM, Barletta GM, Dresner IG, Chand DH, Geary D, Lin JJ, Patel H (2006) Severe cardiac hypertrophy and long-term dialysis: the Midwest Pediatric Nephrology Consortium Study. Pediatr Nephrol 21:1167–1170

    Article  PubMed  Google Scholar 

  22. Hothi DK, Harvey E, Piva E, Keating L, Secker D, Geary DF (2006) Calcium and phosphate balance in adolescents on home nocturnal haemodialysis. Pediatr Nephrol 21:835–841

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Nephrology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13363, Berlin, Germany

    Julia Thumfart, Christina v. Puttkamer, Uwe Querfeld & Dominik Müller

  2. INWT Statistics GmbH, Obentrautstraße 72, 10963, Berlin, Germany

    Steffen Wagner

Authors
  1. Julia Thumfart
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina v. Puttkamer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steffen Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Uwe Querfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominik Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dominik Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thumfart, J., Puttkamer, C.v., Wagner, S. et al. Hemodiafiltration in a pediatric nocturnal dialysis program. Pediatr Nephrol 29, 1411–1416 (2014). https://doi.org/10.1007/s00467-014-2776-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-014-2776-9

Keywords

Search

Navigation