Age- and weight-based differences in haemodialysis prescription and delivery in children, adolescents and young adults. Issue 9 (18th April 2018)

• Record Type: Journal Article
• Authors: Gotta, Verena; Marsenic, Olivera; Pfister, Marc
• Is Part Of: Nephrology dialysis transplantation. Volume 33:Issue 9(2018)
• Page Start: 1649
• Page End: 1660
• Publication Date: 2018-04-18
• Subjects: chronic haemodialysis -- clearance -- dialysis dose -- epidemiology -- obesity -- paediatrics; Nephrology -- Periodicals; Hemodialysis -- Periodicals; Kidneys -- Transplantation -- Periodicals; Hemodialysis; Kidneys -- Transplantation; Nephrology; Periodicals; 616.61
• DOI: 10.1093/ndt/gfy067
• Languages: English
• ISSNs: 0931-0509

Abstract

Abstract: Background: Limited systematic data are available on prescription and dosing of haemodialysis (HD) in children and adolescents compared with adults. We aimed to characterize age- and weight-based differences in HD delivery in children, adolescents and young adults. Methods: This is a retrospective observational study including 1852 patients <30 years on chronic HD from childhood (53 903 HD sessions), receiving thrice weekly outpatient HD between 2004 and 2016 in the USA (6075 patient-years, of which 2535 were in patients aged 1–18 years; weight range 8.3–168 kg). Median individual prescriptions per year were calculated and overall 50% (IQR) and 90% distribution ranges over age and weight were derived. Repeated measurements analysis of variance assessed differences between age and weight groups. Results: Prescriptions significantly differed among age and weight groups (P < 0.001). Lower weight patients (<75 kg) had higher (inter-quartile range, IQR) weight-normalized blood flow rate (highest in <25 kg: QB /kg = 6.5–9.1 mL/min/kg), urea dialytic clearance (KD /kg) and single pool Kt/V (sp Kt/V ) ( < 25 kg: 1.43–1.78; 25–50 kg: 1.52–1.92; 50–75 kg: 1.43–1.74) than heavier patients (lowest in > 100 kg: QB /kg = 3.1–4.0 mL/min/kg, sp Kt/V = 1.22–1.47, respectively). Adolescents had significantly lower QB /kg, KD /kg and sp Kt/V (1.34–1.71) compared with adults (1.45–1.79) and children <12 years (range of 25th percentiles: 1.37–1.44). Dialytic clearance derived from a mechanistic equation underpredicted KD in children but not in young adults. Significant growth retardation was observed, with the proportion of patients <3rd percentile (height for age) decreasing from 71% (1–2 years) to 15% (>18 years). Conclusion: Delivered HD treatment varies with age and weight and is more intensified in children aged <12 years, compared with adolescents and overweight young adults, who appear to be at highest risk of receiving suboptimal treatment. Still, delivery of target or higher sp Kt/V values did not result in appropriate growth in these children, questioning the value of sp Kt/V as a measure of HD adequacy in children. Provided ranges of outpatient HD prescription can help clinicians and researchers in personalizing and optimizing delivery of dialysis treatment.