Rapid accelerated hemodialysis in children with end-stage renal disease: a randomized clinical trial.
In rapid accelerated hemodialysis (R-AHD), blood partially recirculates from the venous (outflow) to the arterial (inflow) line through a recirculation line (R) to selectively increase the filter blood flow rate (BFR). R-AHD PR uses two blood pump segments at the patient segment of the arterial line and at (R). To determine the effectiveness of R-AHD with regard to increasing anticoagulation and dialysis efficiency, we studied ten children with end-stage renal disease in two stages: stage 1 with 10 routine heparin R-AHD, then 10 half-dose heparin R-AHD, then 145 routine heparin R-AHD sessions for 1 month and then routine heparin double needle hemodialysis (DNHD) for one month (control). In stage 2, we dialyzed the patients with 10 routine heparin-mixed AHD PR and DNHD sessions, then eight low-dose heparin R-AHD PR" sessions, then one of the children with 10 no-heparin R-AHD PR sessions and then 10 routine heparin DNHD sessions" (control). Signs of blood clotting and dialysis efficiency were monitored. Blood clots appeared in four out of 165 R-AHD 0 (one pump circuit) sessions but in none of the 28 R-AHD PR sessions. In stage 1, the mean urea reduction rate was 0.60, 0.60 and 0.70 for the R-AHD protocols, compared with 0.71 for the control (P >0.05). In stage 2, the arterial blood urea nitrogen was reduced by 0.66 ± 0.15 after an R-AHD PR period, compared with 0.79 ± 0.18 after a DNHD period (P = 0.059). In conclusion, R-AHD PR allowed successful low heparin and no heparin hemodialysis in children without increasing the patients' BFR. However, the technique did not increase the efficiency of dialysis.
Cairo University Children's Hospital, Cairo, Egypt. melhatw@yahoo.com
Mohamed Khaled
MK
El Hatw
Fatina
F
Fadel
Ramzy
R
El Baroudy
D000293:Adolescent; D002648:Child; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005374:Filtration / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology*; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome; D062666:Vascular Access Devices