Abstract
UF, commonly employed during hemodialysis (HD) as a means of removal of excess fluid, often produces hypotension (HN) requiring treatment with additional fluid. Negative pressure ultrafiltration (NPUF) with a partial vacuum (PV) has been used successfully in adults with few side effects. We performed NPUF 11 times in 7 children on maintenance HD. There were 4 males and 3 females, 8 to 19 years of age; mean 14.2. A PV was created by sealing the inlet of a dialyzer and connecting the outlet by tubing a bottle to a vacuum pump. NP was applied to the dialysate compartment which did not contain dialysate fluid. Dialyzers used ranged from 0.5 to 1.5 m2 surface area. NPUF was from 65-120 minutes (mean 114) at NP of 400-500 mmHg (mean 465). Blood flows through the dialyzers ranged from 60-280 ml/min. Total fluid removed ranged from 800-3300 ml; mean 2509 ml. Fluid removed/hr/patient was 1356 ml while fluid removed/hr/kg body weight was 31 ml. Mean decrease in patient weight was 2.1 kg. Values for urea nitrogen, creatinine, Ca, phos, Mg and electrolytes were similar in blood and ultrafiltrate. Protein content in the ultrafiltrate was zero. One patient developed HN which was asymptomatic; 2 had transient abdominal cramps. Four patients had therapeutic decreased in blood pressure. These studies demonstrate that NPUF can be safely used to remove excess fluid in children undergoing HD.
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