Purpose: An important challenge for a pediatric nephrologist is to achieve in children the innovations of current adult dialytic technology.
Methods: Five children, mean age 14.1 +/- 1.5 yrs, mean weight 31.5 +/- 5.8 kg, mean dialytic age 32 +/- 20 months, were evaluated after a 6-month treatment with paired filtration dialysis (PFD). We used two capillary membranes: a 0.4 m 2 polysulfone hemofilter and a 0.8 m 2 cuprophan dialyzer. There was a reinfusion system (1540 +/- 150 mL/h) between these two filters. QD 500 mL/min and QB 230 +/- 10 mL/min. Ultrafiltration (UF) 2400 mL/h was planned for the hemofilter. At base-line and after 6 months of treatment, in addition, we evaluated routine clinical parameters, and other parameters such as beta2-microglobulin, dialytic adequacy (Kt/V) and nutritional status (dietetic diary). The data were analyzed using the Student's t-test for paired values.
Results: Medium values of small molecules did not demonstrate meaningful variations after 6 months of treatment. The extraction percentage after each session was between 63% phosphorous and 76% for urea, but only 25% for convection. Instantaneous urea clearance after 60 min was 178 +/- 10 mL/min. Dialytic efficiency and nutritional intake were appropriated: Kt/V 1.66 +/- 0.2; PCRn 1.65 +/- 0.2; protein intake 2.2 +/- 0.5 g/kg/die; caloric balance 71.2 +/- 15 Kcal/kg/die; protein balance 0.53 +/- 0.4 g/kg/die; and azotic balance 85.8 +/- 74 mg/kg/die. We confirmed the good depuration capacity from the middle molecules with convective treatments: beta2-microglobulin extraction was 53%. Moreover, in children we found good clinical tolerance to PFD with modest interdialytic symptomatology: headache (8%), hypotension (6%), and cramps and vomiting (<2%). Increased priming of the extracorporeal circuit was not a significant technical problem. The cuprophan membrane has been subsequently replaced with the polysulfone membrane.
Conclusions: We can assert that this technique can also be performed in the pediatric age with similar results as in the adult age: good depuration of the small and averages molecules, good clinical tolerance, and shortening the dialytic sessions.