In the adult population with renal failure, a KT/V of less than 1.2 is associated with higher mortality and aggressive dialysis has been shown to improve survival. Similar data in children are not available. We hypothesize that a more aggressive dialysis regiment, by increasing dialysis time, will lead to beneficial effects on patients blood pressure, serum albumin, and the response of bone marrow to erythropoietin. To test the hypothesis, we prospectively increased dialysis clearance in 17 pediatric hemodialysis patients in our institution. Pre-dialysis systemic blood pressure, number of antihypertensive medications, serum albumin, hemoglobin levels and erythropoietin dose were compared at baseline(time 0), 4 months (time 1), and 12 months (time 2). Results are shown in table1.
Our results show that after one year of more aggressive dialysis, as shown by improvement in urea clearance, a significant improvement is seen in hemoglobin levels with a trend towards a decrease in erythropoietin dose. We were not able to show any improvement in blood pressure control and serum albumin after 4 months and one year of treatment.
