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Kidney Week

Abstract: TH-PO784

Impact of Dialysis Adequacy on Morbidity in Children on Chronic Hemodialysis: A North American Pediatric Renal Trials and Collaborative Studies Report

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Dandamudi, Raja, Washington University in St. Louis School of Medicine, Glencoe, Missouri, United States
  • Martz, Karen, NAPRTCS, Rockville, Maryland, United States
  • Hmiel, Stanley P., St. Louis Children's Hospital, St. Louis, Missouri, United States
  • Dharnidharka, Vikas R., Washington University School of Medicine, St Louis, Missouri, United States
  • Kakajiwala, Aadil K., Washington University in St Louis, St. Louis, Missouri, United States
Background

Reliance on small solute clearance as a measure of dialysis adequacy fails to fully quantify the intended clinical effects of dialysis therapy. We aimed to study the relationship between dialysis adequacy, as measured by single-pool Kt/V (spKt/V) and urea reduction ratio (URR), and patient morbidity as measured by growth, nutrition and anemia control.

Methods

We included 391 patients (median age of 14.3 years [range: 1.0 - 18.9]) in the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) database receiving chronic hemodialysis three times a week. Using goal sp Kt/V of 1.2-1.5 and URR of 65-75% we compared weight, height, albumin, hemoglobin (Hb) and erythropoiesis stimulating agent (ESA) dose at 12 months from initiation of HD (initiated between Jan '03 to Dec '18). Kruskal-Wallis test was used to compare these measures in patients at, above, and below goal values of dialysis adequacy.

Results


Results of the univariate analysis are summarized (Table 1A & B). For patients with URR and spKT/V above goal, the median weight z-scores was 0.6 and 0.7 points lower when compared to those with values within goal levels. Similarly, for patients with URR and spKT/V above goal, the height z-scores was 1.0 and 0.8 lower than the within goal levels. Patients with URR < 65% had 0.7 g/dL higher median Hb compared to within goal levels of URR. We noted no significant relationship between dialysis adequacy and serum albumin, ESA doses

Conclusion

Preliminary results show significantly lower weight and height in patients with dialysis adequacy above goal values. This may reflect low volumes of distribution (V). Further analysis of the database at multiple time points from initiation of HD with help describe associations between dialysis adequacy and patient morbidity.