title: Intensified home haemodialysis for managing severe cardiac failure.
abstract: BACKGROUND
  Conventional thrice weekly haemodialysis (HD) provides adequate dialysis to prevent mortality, but morbidity is prevalent in both the paediatric and adult population. There has been growing interest in the potential of intensive dialysis regimes entering the realm of optimal dialysis, with superior health and quality of life outcomes.
  
  
  METHODS
  We present the case of a 13-year-old girl who had bilateral nephrectomies as a result of bilateral Wilms tumors. In the third year of treatment with conventional HD, she presented with symptomatic progressive cardiac failure, presumably secondary to anthracycline-induced cardiomyopathy. Consequently, she was taken off the renal transplant list and became increasingly dependent on frequent in-centre dialysis sessions to manage her symptoms. Five months after switching to a frequent and extended home HD regime, we observed a tremendous improvement in her health and well-being, with complete reversal of her cardiac dysfunction.
  
  
  CONCLUSIONS
  Home HD is a practically viable option in children with severe cardiac dysfunction. Gentler, more intensive dialysis will draw out and improve the ureamic component of heart disease. This may translate into improved cardiac function.
authors.affiliation: Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, WC1N 3JH.
authors.forename: Nabil Z
authors.initials: NZ
authors.lastname: Melhem
authors.forename: Pallavi
authors.initials: P
authors.lastname: Yadav
authors.forename: Lynsey
authors.initials: L
authors.lastname: Stronach
authors.forename: Daljit K
authors.initials: DK
authors.lastname: Hothi
mesh_terms: D000293:Adolescent; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006437:Hemodialysis, Home / Q000379:methods*; D006801:Humans; D012720:Severity of Illness Index