Efficacy and safety of prolonged daily hemodialysis in critically ill children weighing less than 10 kg.

Abstract

Extracorporeal renal replacement therapy may be needed in those infants in whom peritoneal dialysis is not feasible or is ineffective. Prolonged daily hemodialysis (PDHD) remains the only available extracorporeal dialytic modality in children weighing less than 10 kg, in setups where continuous renal replacement therapy is unavailable and sustained low-efficiency dialysis is not feasible due to lack of dedicated HD machines capable of delivering very low dialysate flows. The use of PDHD in critically ill children weighing less than 10 kg has not received much attention. Retrospective analysis of the efficacy and safety of PDHD in critically ill children weighing less than 10 kg. Four critically ill children received a total of 49 sessions of PDHD for acute kidney injury (AKI) associated with sepsis and multiorgan dysfunction syndrome (MODS). PDHD was delivered for a duration of 6 to 8 hours daily with low ultrafiltration rates, low blood flow rates but with dialysate rates that were four times the blood flow rates, due to limitations of minimal dialysate flow rate on standard machines. The mean duration of the sessions was 6.59 ± 1.61 hours. Mean hourly ultrafiltrate (UF) rate during the sessions was 9.28 ± 2.57/kg/hour with mean patient fluid removal rate of 5.4 ± 2.56 mL/kg/hour. Predialysis serum creatinine decreased to 30% of the starting value by the fourth hemodialysis (HD) session. Thirty-three (67.4%) sessions were heparin free. Intradialytic hypotension occurred in 10 (20.4%) sessions. Premature termination of the session occurred in six (12.4%), due to hypotension in two and filter clotting in four. Hypokalemia was seen in 12 (24.4%) and hypophosphatemia in 6 (12.24%). All four patients survived. On follow-up, three are dialysis free and one is on maintenance hemodialysis. PDHD is effective and safe in critically ill small children.