International Journal of Nephrology / 2011 / Article / Tab 1

Review Article

Optimal Hemodialysis Prescription: Do Children Need More Than a Urea Dialysis Dose?

Table 1

Adequate hemodialysis prescription for children: more than a urea dialysis dose (adapted from [4, 5, 11, 19, 27]).

(i)Hemodialysis should be performed in a pediatric dialysis center, in order to ensure optimal care and child development (nutrition, growth, education)
(ii)A complete dialysis dose should be prescribed, not only a urea dialysis dose, that is, sp Kt/V > 1.4 in anuric patients, but also a high convective volume. Phosphate and β2 m can be used as markers for the removal of “middle-sized uremic molecules.”
(iii)Prefer biocompatible materials where possible, that is, high-flux membranes which provide enhanced molecular permeability. High-flux membranes, especially in cases of high hydraulic permeability, require the use of ultrapure dialysate, that is, a bacterial count <0.1 CFU/mL and an endotoxin count <0.05 UI/mL.
(iv)Control blood pressure and aim for prevention of cardiovascular sequelae such as left ventricular hypertrophy, left ventricular dysfunction, coronary artery calcifications, and vascular stiffness.
(v)Ensure optimal nutrition, that is, limit malnutrition and cachexia in order to avoid muscle wasting and to promote growth and development.
(vi)Propose an intensified hemodialysis regimen, that is, longer and/or more frequent dialysis in center or at home, not only for use as a rescue therapy.
(vii)Deliver the highest standard of dialysis possible in all cases, that is, biocompatibility of the material used, monitor the purity of the dialysate, and use a controlled determined convective flow instead of an internal, small, nondetermined flow with backfiltration into the dialyzer.

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