No abstract

In this pediatric cohort, intensive center hemodialysis was associated with excellent growth, nutrition, Ca, P, and anemia control and reasonable blood pressure values. Large multicenter studies are needed to better determine optimal dialysis therapy for children.

Multicompartment urea kinetics in well-dialyzed children. mum delivered K d t/V of 1.2 [1]. Extrapolation from adult Background. We have reported catch-up growth with hemostudies may be problematic, as more appropriate pediatdialysis (HD) of approximately 15 hours/week. Without an ric outcome measures-such as growth, school perforequilibrated post-treatment blood urea nitrogen, the variablemance, or pubertal development-might lead to very volume single-pool (VVSP) model will not account for urea different conclusions as to the relative importance of rebound, inflating the estimated HD dose (K d t/V). A two-pool model (FVDP) predicts rebound, but requires fixed compartthe small molecular weight toxins for which urea is a ment volumes for the equations to be solvable in closed form, surrogate marker. Prior to the introduction of recombialso inflating K d t/V. nant human growth hormone (rhGH), the mean annual Methods. We developed an approximate perturbation soluloss in height standard-deviation score (⌬HSDS) in pretion (WKB method) to a variable volume, two-pool (VVDP) pubertal HD patients was Ϫ0.4 to Ϫ0.8 SD/year [2]. model. Estimated model parameters were compared with the results of equilibrated kinetic studies using measured clearance However, we have recently described normal growth K d (N ϭ 17). Once the model was validated, we re-analyzed rates, catch-up growth, and normal puberty with inten-292 kinetic studies from our earlier cohort, which was considsive nutritional support and HD clearance in prepubertal ered well-dialyzed on the basis of growth rates (N ϭ 12, mean patients treated without rhGH [3]. With a weekly treatannual change in height standard deviation score ϩ0.31, mean ment time of approximately 15 hours and a single-pool follow-up of 26 months). Results. For the VVSP, FVDP, and VVDP models, respecurea K d t/V of approximately 2.0, the mean annual tively, the mean errors were (1) K d t/V, 0.22 Ϯ 0.07, 0.29 Ϯ ⌬HSDS was Ͼϩ0.3 SD/year, and predicted final adult 0.17, 0.06 Ϯ 0.07 (ANOVA, P Ͻ 0.001); (2) urea distribution height fell generally within 2 SD of genetic potential.