title: Intensive in-center hemodialysis for children: a case for longer dialysis duration.
abstract: BACKGROUND
  Children with renal failure need their dialysis time optimized. Although traditional surrogate markers of outcome in pediatric patients have been growth and development, increasing attention is being focused on cardiovascular risk factors, such as hypertension, volume overload, malnutrition, and elevated calcium (Ca) and phosphorus (P) levels. We have previously shown catch-up growth without growth hormone, in children undergoing long intermittent hemodialysis. Recently we analyzed retrospectively cardiovascular risk factors in patients treated with this regimen.
  
  
  METHODS
  Patients starting dialysis between 1997 and 2001 and on dialysis at least 6 months were evaluated. Charts were reviewed for Ca, P, parathyroid hormone (PTH), albumin, hemoglobin and blood pressure levels, Ca intake, blood pressure medications, dialysis time, and clearance and ultrafiltration rates. Means were calculated for 6- month intervals, up to 36 months.
  
  
  RESULTS
  Mean equilibrated dialyzer Kt/V(urea)ranged from 1.9 to 2.1, and mean weekly dialysis time for oliguric patients varied from 14.8 to 16.3 hr, with average hourly ultrafiltration rates from 0.3 to 0.4 L. Mean values for P and Ca x P were below 1.8 mM and 4.4 mmol (2)/L(2), respectively. Mean hemoglobin levels were 115 to 126 g/L, albumin 39 to 41 g/L, and PTH 156 to 231 pg/mL. Most patients had normal predialysis blood pressures.
  
  
  CONCLUSIONS
  In this pediatric cohort, intensive center hemodialysis was associated with excellent growth, nutrition, Ca, P, and anemia control and reasonable blood pressure values. Large multicenter studies are needed to better determine optimal dialysis therapy for children.
authors.affiliation: Montreal Children's Hospital, Department of Pediatrics, Division of Nephrology, Montreal, Quebec, Canada. lorraine.bell@muhc.mcgill.ca
authors.forename: Lorraine
authors.initials: L
authors.lastname: Bell
authors.forename: Pauline
authors.initials: P
authors.lastname: Espinosa