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Abstract: FR-PO1157

Ultrafiltration Rates Observed in a Large Pediatric Hemodialysis Cohort Routinely Exceed Weight Based Adult Limit: Call for Action

Session Information

  • Pediatric Nephrology - I
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

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

Ultrafiltration rates (UFR) in adult hemodialysis (HD) patients of >10 and especially >13 ml/kg/hr were found to be associated with greater risk of cardiovascular (CV) morbidity and mortality, leading to limiting UFR in adults to 13 ml/kg/hr. CV disease is the main cause of death in children on HD. Children have higher need for UF than adults to allow adequate nutrition and growth, but there is no data of UFR routinely provided to children. This is the first study to report UFR from a large pediatric HD cohort.

Methods

We retrospectively analyzed data from 17844 HD sessions in 1592 children and adolescents 1-18 years and weight (wt) 8.3-163 kg, receiving standard outpatient HD in DaVita centers between 2004 and 2016. There were total of 2535 patient-years with median 16 (interquartile range (IQR): 5-42) HD sessions per patient. Median UFR [ml/kg/hr; (preWt-postWt)/postWt/hr)] was calculated for each patient and year of age. HD was provided 3x/week for a duration of 1.75-5 (median 3.25, IQR: 3.0-3.6) hrs. UFR of >10 and >13 were analyzed in relation to age, weight and HD duration (Chi-squared/Fisher-exact test).

Results

UFR was significantly different between patients of different age and wt, and among patients receiving different HD duration (Table). UFR >10 and >13 ranged between 35-57% and 17-46% respectively based on age (P<0.05) while it was 14-62% and 1-43% respectively based on wt (P<0.001). Patients with highest UFR were 6-11 years old and weighed 25-50 kg. UFR >13 mL/kg/min remained similar (30-34%) for HD durations 93-210 min, but decreased to 27% and 18% for longer sessions of 211-240 and >240 min, respectively.

Conclusion

Pediatric UFR frequently exceed upper limit recommended for adults if HD lasts <4 hrs especially in children weighing 25-50 kg. Additional studies are needed to define pediatric-specific upper UFR limits that could decrease CV mortality. If lower UFR is found to be beneficial in children, a global change in chronic pediatric HD prescription will be required allowing longer and/or more frequent HD treatments.

Funding

  • Private Foundation Support