title: Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis.
abstract: BACKGROUND
  To compare the efficacy of the Newcastle infant dialysis and ultrafiltration system (Nidus) with peritoneal dialysis (PD) and conventional haemodialysis (HD) in infants weighing <8 kg.
  
  
  METHODS
  We compared the urea, creatinine and phosphate clearances, the ultrafiltration precision, and the safety of the Nidus machine with PD in 7 piglets weighing 1-8 kg, in a planned randomised cross-over trial in babies, and in babies for whom no other therapy existed, some of whom later graduated to conventional HD.
  
  
  RESULTS
  Two babies entered the randomised trial; 1 recovered rapidly on PD, the other remained on the Nidus as PD failed. Additionally, 9 babies were treated on the Nidus on humanitarian grounds: 3 because of failed PD, and 3 with permanent kidney failure later converted to conventional HD. We haemodialysed 10 babies weighing between 1.8 and 5.9 kg for 2,475 h during 354 Nidus sessions without any clinically important incidents, and without detectable haemolysis. Single-lumen vascular access was used with no blood priming of circuits. The urea, creatinine and phosphate clearances using the Nidus were around 1.5 to 2.0 ml/min in piglets and babies, and were consistently higher than PD clearances, which ranged from about 0.2 to 0.8 ml/min (p ≤ 0.0002 for each chemical). Ultrafiltration was achieved to microlitre precision by the Nidus, but varied widely with PD. Fluid removal using conventional HD was imprecise and resulted in some hypovolaemic episodes requiring correction.
  
  
  CONCLUSIONS
  The Nidus can provide HD in the Pediatric Intensive Care Unit (PICU) and outpatient intermittent HD without blood priming for babies weighing <8 kg, It generates higher dialysis clearances than PD, and delivers more precise ultrafiltration control than either PD or conventional HD.
authors.affiliation: Department of Paediatric Nephrology, Great North Children's Hospital, Newcastle, NE1 4LP, UK, malcolm.coulthard@nuth.nhs.uk.
authors.forename: Malcolm G
authors.initials: MG
authors.lastname: Coulthard
authors.forename: Jean
authors.initials: J
authors.lastname: Crosier
authors.forename: Clive
authors.initials: C
authors.lastname: Griffiths
authors.forename: Jon
authors.initials: J
authors.lastname: Smith
authors.forename: Michael
authors.initials: M
authors.lastname: Drinnan
authors.forename: Mike
authors.initials: M
authors.lastname: Whitaker
authors.forename: Robert
authors.initials: R
authors.lastname: Beckwith
authors.forename: John N S
authors.initials: JN
authors.lastname: Matthews
authors.forename: Paul
authors.initials: P
authors.lastname: Flecknell
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Lambert
mesh_terms: D058186:Acute Kidney Injury / Q000628:therapy*; D000818:Animals; D005260:Female; D017583:Hemodiafiltration / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010530:Peritoneal Dialysis / Q000379:methods; D006435:Renal Dialysis / Q000379:methods; D013552:Swine