title: Pediatric hemofiltration: Normocarb dialysate solution with citrate anticoagulation.
abstract: Fourteen children, newborn to 17 years of age, underwent continuous veno-venous hemofiltration with dialysis (CVVHD), using a new FDA-approved bicarbonate-based calcium-free dialysis solution (Normocarb) in combination with citrate anticoagulation. Dialysis prescription included use of the PRISMA system (Gambro, Lakewood, Colo., USA), with ACD-A (Baxter, Deerfield, Ill., USA) for anticoagulation and Normocarb (Dialysis Solution, Richmond Hills, Ontario, Canada) for dialysate. Diagnosis included 11 children with sepsis and 3 children with tumor lysis syndrome. Mean weight was 31.6+/-4.7 kg (range 3.7-62 kg) and average length of therapy was 11.4+/-3.7 days (range 6 h to 67 days). Length of circuit patency was 71.3+/-7.2 h (range 6 h to 127 h), which was influenced in part by a decision to change circuits at 72 h as per manufacturer's recommendation. No bleeding occurred. This protocol utilizes industry-manufactured CVVHD machinery with both thermic and ultrafiltration control, with an effective anticoagulation protocol, and industry-produced bicarbonate dialysate. The use of industry machinery and solutions allows for consistent industrial quality assurance standards. This potentially may decrease the cost of therapy and minimize the risk of pharmacy errors that can occur with pharmacy-made dialysis solutions.
authors.affiliation: Division of Pediatric Nephrology and Transplantation, Children's Hospital of Alabama, University of Alabama at Birmingham, CHT 735, 1600 7th Avenue S, Birmingham, AL 35233, USA. tbunchman@peds.uab.edu
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Bunchman
authors.forename: Norma J
authors.initials: NJ
authors.lastname: Maxvold
authors.forename: Joni
authors.initials: J
authors.lastname: Barnett
authors.forename: Anne
authors.initials: A
authors.lastname: Hutchings
authors.forename: Mark R
authors.initials: MR
authors.lastname: Benfield
mesh_terms: D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage*; D001639:Bicarbonates / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019343:Citric Acid / Q000008:administration & dosage*; D015314:Dialysis Solutions / Q000627:therapeutic use*; D006440:Hemofiltration; D006801:Humans; D007223:Infant; D018805:Sepsis / Q000628:therapy; D015275:Tumor Lysis Syndrome / Q000628:therapy
chemical_list: D000925:Anticoagulants; D001639:Bicarbonates; D015314:Dialysis Solutions; D019343:Citric Acid