title: Hemodiafiltration in a pediatric nocturnal dialysis program.
abstract: BACKGROUND
  To overcome the deleterious consequences of conventional dialysis, intensified dialysis programs have been developed and their feasibility and beneficial effects in children demonstrated. To investigate whether such a program can be further improved, we implemented hemodialfiltration within an established pediatric in-center, nocturnal hemodialysis program.
  
  
  METHODS
  After being started on conventional hemodialysis (HD), seven patients were switched to intermittent nocturnal hemodialysis (NHD) for 3 months, then to intermittent nocturnal online-hemodiafiltration (NHDF) for a further 3 months and finally back to NHD. Uremia-associated parameters, predialytic blood pressure, intradialytic events, protein catabolic rate and levels of albumin, vitamins and trace elements were investigated. Dialysis-related medication and dietary restrictions were also registered.
  
  
  RESULTS
  Phosphate and intact parathyroid hormone levels were reduced after the switch from HD to NHD and NHDF. Dialysis dose (Kt/V) was increased in patients on NHD and NHDF; however, Kt/V was significantly higher with NHDF than NHD. Blood pressure was significantly reduced in patients on NHD and NHDF despite the reduction in antihypertensive medication; albumin levels were significantly higher on NHD and NHDF, indicating improved nutritional status; protein catabolic rate was also increased. Vitamins and trace elements remained unchanged. All dietary restrictions could be lifted in patients on NHD and NHDF.
  
  
  CONCLUSIONS
  The introduction of a nocturnal dialysis program to an existing intensified HD program significantly improved the uremia-associated parameters, nutrition and hemodynamic stability of our seven patients. At least during our observational period, hemodiafiltration was able to further improve the existing HD program by increasing the Kt/v.
authors.affiliation: Department of Pediatric Nephrology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13363, Berlin, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Thumfart
authors.forename: Christina V
authors.initials: CV
authors.lastname: Puttkamer
authors.forename: Steffen
authors.initials: S
authors.lastname: Wagner
authors.forename: Uwe
authors.initials: U
authors.lastname: Querfeld
authors.forename: Dominik
authors.initials: D
authors.lastname: Müller
mesh_terms: D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology; D002118:Calcium / Q000378:metabolism; D002648:Child; D004032:Diet; D005260:Female; D017583:Hemodiafiltration / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007022:Hypotension / Q000503:physiopathology; D007674:Kidney Diseases / Q000628:therapy; D008297:Male; D009752:Nutritional Status; D010710:Phosphates / Q000378:metabolism; D006435:Renal Dialysis / Q000295:instrumentation / Q000379:methods*; D014508:Urea / Q000378:metabolism
chemical_list: D010710:Phosphates; D014508:Urea; D002118:Calcium