Abstract
Recent evidence from adult hemodialysis (HD) patient studies reveal improved biochemical control and reported health-related quality of life after transition from conventional thrice weekly to daily home maintenance HD treatment. Published pediatric frequent dialysis experiences demonstrate similar improvement but all used conventional HD machines, which employ a treated municipal water supply, thereby frequently exposing patients to proinflammatory components. We report our pediatric experience with six-times-weekly HD using the NxStage™ system, which uses sterile dialysis fluid to provide dialysis in the home or center setting. Four patients (weight range 38–61.4 kg) completed the 16-week study. Patients exhibited progressive reductions in casual pretreatment systolic and diastolic blood pressures, discontinuation of antihypertensive medications, and decreased blood pressure load by ambulatory blood pressure monitoring. Mean serum phosphorus improved without change in phosphorus binder medication, and all three patients with a normalized protein catabolic rate <1 g/kg per day at the beginning of the study improved to a normalized protein catabolic rate (nPCR) of >1.1 g/kg per day. Patients reported no adverse effects. Variable changes in proinflammatory cytokine levels were observed. We suggest that frequent HD with the NxStage™ system be considered for children who would benefit from home-based maintenance dialysis.
Similar content being viewed by others
References
US Renal Data System (2006) Excerpts from the 2005 USRDS Annual Report. Am J Kidney Dis 47(Suppl 1):S1–S286
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, Kusek JW, Allon M, Bailey J, Delmez JA, Depner TA, Dwyer JT, Levey AS, Levin NW, Milford E, Ornt DB, Rocco MV, Schulman G, Schwab SJ, Teehan BP, Toto R; Hemodialysis (HEMO) Study Group (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347:2010–2019
Goldstein SL (2004) Adequacy of dialysis in children: does small solute clearance really matter? Pediatr Nephrol 19:1–5
National Kidney Foundation (2006) KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates: hemodialysis adequacy, peritoneal dialysis adequacy, and vascular access. Am J Kidney Dis 48:S1–S322
Fischbach M, Edefonti A, Schroder C, Watson A (2005) Hemodialysis in children: general practical guidelines. Pediatr Nephrol 20:1054–1066
Blagg CR, Kjellstrand CM, Ting GO, Young BA (2006) Comparison of survival between short-daily hemodialysis and conventional hemodialysis using the standardized mortality ratio. Hemodial Int 10:371–374
Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S (2003) Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis 42:1020–1035
Williams AW, Chebrolu SB, Ing TS, Ting G, Blagg CR, Twardowski ZJ, Woredekal Y, Delano B, Gandhi VC, Kjellstrand CM (2004) Early clinical, quality-of-life, and biochemical changes of “daily hemodialysis” (6 dialyses per week). Am J Kidney Dis 43:90–102
Goldstein SL, Currier H, Watters L, Hempe JM, Sheth RD Silverstein D (2003) Acute and chronic inflammation in pediatric patients receiving hemodialysis. J Pediatr 143:653–657
Goldstein SL, Leung JC, Silverstein DM (2006) Pro- and anti-inflammatory cytokines in pediatric dialysis patients: effect of aspirin. Clin J Am Soc Nephrol 1:979–986
Gorman G, Fivush B, Frankenfield D, Warady B, Watkins S, Brem A, Neu A (2005) Short stature and growth hormone use in pediatric hemodialysis patients. Pediatr Nephrol 20:1794–1800
Tom A, McCauley L, Bell L, Rodd C, Espinosa P, Yu G, Yu J, Girardin C, Sharma A (1999) Growth during maintenance hemodialysis: impact of enhanced nutrition and clearance. J Pediatr 134:464–471
Fischbach M, Terzic J, Menouer S, Dheu C, Soskin S, Helmstetter A, Burger MC (2006) Intensified and daily hemodialysis in children might improve statural growth. Pediatr Nephrol 21:1746–1752
Geary DF, Piva E, Tyrrell J, Gajaria MJ, Picone G, Keating LE, Harvey EA (2005) Home nocturnal hemodialysis in children. J Pediatr 147:383–387
Yuen D, Richardson RM, Fenton SS, McGrath-Chong ME, Chan CT (2005) Quotidian nocturnal hemodialysis improves cytokine profile and enhances erythropoietin responsiveness. ASAIO J 51:236–241
Schwartz DI, Pierratos A, Richardson RM, Fenton SS, Chan CT (2005) Impact of nocturnal home hemodialysis on anemia management in patients with end-stage renal disease. Clin Nephrol 63:202–208
Jaber BL, Zimmerman DL, Teehan GS, Swedko P, Burns K, Meyer KB, Leypoldt JK (2004) Daily hemofiltration for end-stage renal disease: a feasibility and efficacy trial. Blood Purif 22:481–489
Michael M, Brewer ED, Goldstein SL (2004) Blood volume monitoring to achieve target weight in pediatric hemodialysis patients. Pediatr Nephrol 19:432–437
Leypoldt JK, Jaber BL, Zimmerman DL (2004) Predicting treatment dose for novel therapies using urea standard Kt/V. Semin Dial 17:142–145
Goldstein SL, Graham N, Burwinkle T, Warady B, Farrah R, Varni JW (2006) Health-related quality of life in pediatric patients with ESRD. Pediatr Nephrol 21:846–850
Goldstein SL, Smith CM, Currier H (2003) Noninvasive interventions to decrease hospitalization and associated costs for pediatric patients receiving hemodialysis. J Am Soc Nephrol 14:2127–2131
Jain SR, Smith L, Brewer ED, Goldstein SL (2001) Non-invasive intravascular monitoring in the pediatric hemodialysis population. Pediatr Nephrol 16:15–18
Patel HP, Goldstein SL, Mahan JD, Smith B, Fired CB, Currier H, Flynn JT (2007) A standard, noninvasive monitoring of hematocrit algorithm improves blood pressure control in pediatric hemodialysis patients. Clin J Am Soc Nephrol 2:252–257
Orellana P, Juarez-Congelosi M, Goldstein SL (2005) Intradialytic parenteral nutrition treatment and biochemical marker assessment for malnutrition in adolescent maintenance hemodialysis patients. J Ren Nutr 15:312–317
Juarez-Congelosi M, Orellana P, Goldstein SL (2007) Normalized protein catabolic rate versus serum albumin as a nutrition status marker in pediatric patients receiving hemodialysis. J Ren Nutr 17:269–274
Wang AY, Woo J, Wang M, Sea MM, Ip R, Li PK, Lui SF, Sanderson JE (2001) Association of inflammation and malnutrition with cardiac valve calcification in continuous ambulatory peritoneal dialysis patients. J Am Soc Nephrol 12:1927–1936
Canaud B, Bosc JY, Leray H, Morena M, Stec F (2000) Microbiologic purity of dialysate: rationale and technical aspects. Blood Purif 18:200–213
McFarlane PA, Pierratos A, Redelmeier DA (2002) Cost savings of home nocturnal versus conventional in-center hemodialysis. Kidney Int 62:2216–2222
Chavers BM, Li S, Collins AJ, Herzog CA (2002) Cardiovascular disease in pediatric chronic dialysis patients. Kidney Int 62:648–653
Sarnak MJ, Levey AS (2000) Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 35:S117–S131
Acknowledgements/Disclosure
This study was supported by grant funding from NxStage Incorporated. NxStage had no editorial control over the results presented or discussion points. The authors thank Joe Turk from NxStage for his support of this project.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Goldstein, S.L., Silverstein, D.M., Leung, J.C. et al. Frequent hemodialysis with NxStage™ system in pediatric patients receiving maintenance hemodialysis. Pediatr Nephrol 23, 129–135 (2008). https://doi.org/10.1007/s00467-007-0649-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0649-1