TY - JOUR
T1 - Incremental hemodialysis in pediatric patients
AU - Evgenia, Gurevich
AU - Yafa, Falush
AU - Hadas, Alfandari
AU - Shelly, Levi
AU - Amit, Dagan
AU - Landau, Daniel
AU - Orly, Haskin
N1 - Publisher Copyright:
© 2023, The Author(s) under exclusive licence to Italian Society of Nephrology.
PY - 2023/7
Y1 - 2023/7
N2 - Background: Incremental hemodialysis follows the concept of adjusting dialysis dose according to residual kidney function. Data on incremental hemodialysis in pediatric patients is lacking. Methods: We conducted a retrospective analysis of children initiating hemodialysis between January 2015 and July 2020 in a single tertiary center, comparing the characteristics and outcomes of those who commenced with incremental hemodialysis vs with conventional thrice-weekly regimen. Results: Data on forty patients, 15 (37.5%) on incremental hemodialysis and 25 (63%) on thrice-weekly hemodialysis were analyzed. No differences in age, estimated glomerular filtration rate and metabolic parameters were noted between groups at baseline, but there were more males (73 vs 40%, p = 0.04), more patients with congenital anomalies of kidney and urinary tract (60 vs 20%, p = 0.01), higher urine output (2.5 ± 1 vs 1 ± 0.8 ml/kg/h, p < 0.001), lower use of antihypertensive medications (20 vs 72%, p = 0.002) and lower prevalence of left ventricular hypertrophy (6.7 vs 32%, p = 0.003) in the incremental hemodialysis group vs thrice-weekly hemodialysis. During follow up, 5 (33%) incremental hemodialysis patients were transplanted, 1 (7%) remained on incremental hemodialysis at 24 months, and 9 (60%) transitioned to thrice-weekly hemodialysis at a median (IQR) time of 8.7 (4.2, 11.8) months. At last follow up, fewer patients who initiated incremental hemodialysis had left ventricular hypertrophy (0 vs 32%, p = 0.016) and urine output < 100 ml/24 h (20 vs 60%, p = 0.02) compared to thrice-weekly hemodialysis, with no significant differences in metabolic or growth parameters. Conclusion: Incremental hemodialysis is a viable option for initiating dialysis in selected pediatric patients, that may help improve patients’ quality of life and reduce dialysis burden without compromising clinical outcome. Graphical abstract: [Figure not available: see fulltext.]
AB - Background: Incremental hemodialysis follows the concept of adjusting dialysis dose according to residual kidney function. Data on incremental hemodialysis in pediatric patients is lacking. Methods: We conducted a retrospective analysis of children initiating hemodialysis between January 2015 and July 2020 in a single tertiary center, comparing the characteristics and outcomes of those who commenced with incremental hemodialysis vs with conventional thrice-weekly regimen. Results: Data on forty patients, 15 (37.5%) on incremental hemodialysis and 25 (63%) on thrice-weekly hemodialysis were analyzed. No differences in age, estimated glomerular filtration rate and metabolic parameters were noted between groups at baseline, but there were more males (73 vs 40%, p = 0.04), more patients with congenital anomalies of kidney and urinary tract (60 vs 20%, p = 0.01), higher urine output (2.5 ± 1 vs 1 ± 0.8 ml/kg/h, p < 0.001), lower use of antihypertensive medications (20 vs 72%, p = 0.002) and lower prevalence of left ventricular hypertrophy (6.7 vs 32%, p = 0.003) in the incremental hemodialysis group vs thrice-weekly hemodialysis. During follow up, 5 (33%) incremental hemodialysis patients were transplanted, 1 (7%) remained on incremental hemodialysis at 24 months, and 9 (60%) transitioned to thrice-weekly hemodialysis at a median (IQR) time of 8.7 (4.2, 11.8) months. At last follow up, fewer patients who initiated incremental hemodialysis had left ventricular hypertrophy (0 vs 32%, p = 0.016) and urine output < 100 ml/24 h (20 vs 60%, p = 0.02) compared to thrice-weekly hemodialysis, with no significant differences in metabolic or growth parameters. Conclusion: Incremental hemodialysis is a viable option for initiating dialysis in selected pediatric patients, that may help improve patients’ quality of life and reduce dialysis burden without compromising clinical outcome. Graphical abstract: [Figure not available: see fulltext.]
KW - Hemodialysis
KW - Incremental dialysis
KW - Pediatrics
KW - Twice-a week
UR - http://www.scopus.com/inward/record.url?scp=85161371747&partnerID=8YFLogxK
U2 - 10.1007/s40620-023-01668-y
DO - 10.1007/s40620-023-01668-y
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C2 - 37341967
AN - SCOPUS:85161371747
SN - 1121-8428
VL - 36
SP - 1571
EP - 1580
JO - Journal of Nephrology
JF - Journal of Nephrology
IS - 6
ER -