| | (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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