Hemodiafiltration in a pediatric nocturnal dialysis program

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Abstract
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. 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. 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. 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.

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