Home nocturnal hemodialysis in children.
OBJECTIVE
To describe the effect of home nocturnal hemodialysis (NHD) in North American children.


METHODS
Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistulae for periods of 6 to 12 months. Blood flow approximated 200 mL/min, and dialysate flow was 300 mL/min; the dialysate contained potassium and phosphate. The procedure was remotely monitored.


RESULTS
The children had unrestricted diets and fluid allowance and did not require phosphate binders. Persistent relative hypotension developed in 2 of 4 children. Weekly Kt/V urea values were consistently >10; other biochemical measures varied. Quality of life and school attendance improved in 3 of 4 children. The workload and reported emotional burden of NHD was substantial. No significant complications occurred. Dialysate losses of calcium, phosphate and carnitine required supplementation. The annual cost per patient was dollar 64,000 Canadian, which represented a 27% savings compared with thrice weekly in-center hemodialysis.


CONCLUSIONS
NHD is feasible in selected children, allows free dietary and fluid intake, and improves patient wellbeing. The burden on the family is substantial, and NHD requires support of a dedicated multidisciplinary team.
Geary
Denis F
DF
Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada. geary@sickkids.ca
Piva
E
E
Tyrrell
J
J
Gajaria
M J
MJ
Picone
G
G
Keating
L E
LE
Harvey
E A
EA
D000293:Adolescent; D002170:Canada; D002648:Child; D005260:Female; D006437:Hemodialysis, Home / Q000191:economics* / Q000523:psychology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D017060:Patient Satisfaction; D011788:Quality of Life