Abstract: FR-PO794

Hemodialysis Prescription Patterns in a Large Cohort of Pediatric Patients on Maintenance Hemodialysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Gotta, Verena, University of Basel Children''s Hospital, Basel, Switzerland
  • Marsenic Couloures, Olivera, Yale University School of Medicine, New Haven, Connecticut, United States
  • Pfister, Marc, University of Basel Children's Hospital, Basel, Switzerland, Hilterfingen, Switzerland
Background

Hemodialysis (HD) prescription is relatively standardized in adults, compared to children. Limited systematic data on HD prescription behavior in children and adolescents is available. We aimed to provide reference ranges of real-life pediatric HD prescriptions.

Methods

This descriptive cohort study included 53903 HD sessions of 1852 patients <30 years on chronic HD since childhood, receiving thrice weekly HD between 2004 and 2016 in outpatient DaVita dialysis (6075 patient-years, 1-29 years, 8.3-168 kg). Median and 10th to 90th percentiles (80% reference ranges) of prescriptions were calculated over age and weight-bands of 10 kg, from median individual prescriptions per year for: blood flow (QB), dialysate flow (QD), mass-transfer coefficient for urea (KoA), duration of HD session, resulting dialytic clearance for urea (KD) and single pool variable-volume Kt/V (spKt/V). Both absolute and weight-normalized flows were investigated. Means ±standard deviation were summarized over five larger age and weight groups.

Results

Prescription parameters were correlated with age and weight, and showed non-linear dependencies. Inter-individual variability was larger between patients of same age (larger reference intervals) than of same weight. Systematic prescription differences were however more pronounced between patients of different weight (see Table). Generally, low-weight patients had higher weight-normalized QB, QD, KoA, KD and spKt/V. More than 90% (70%) of patients 10-80 kg achieved target spKt/V of ≥1.2 (≥1.4). spKt/V was steadily decreasing with higher weight, with only 75% (36%) of patients 110-120 kg achieving target values of ≥1.2 (≥1.4).

Conclusion

HD prescription components are systematically different in children compared to adults, with smaller patients routinely receiving more intensified treatments. Adolescents and young adults with weight >80 kg appear to be at higher risk of receiving suboptimal HD treatment as compared to children ≤80 kg.

Weight<25kg25-50kg50-75kg75-100kg>100kg
QB (mL/min/kg)8.2±2.97.8±1.66.5±1.24.8±0.83.5±0.6
QD (mL/min/kg)28.0±9.815.3±3.211.3±2.18.0±1.46.1±1.0
KoA (mL/min/kg)22.8±8.224.5±5.118.5±3.013.7±2.010.5±1.6
KD (mL/min/kg)5.6±1.05.3±1.04.4±7.03.5±0.52.8±0.5
Duration (min)181±20192±24205±25217±24232±27
spKt/V1.63±0.311.73±0.331.59±0.261.44±0.221.33±0.22

mean ± standard deviation