Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?
Identifieur interne : 001463 ( Istex/Corpus ); précédent : 001462; suivant : 001464Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?
Auteurs : M. Fischbach ; J. Terzic ; V. Laugel ; P. Helms ; A. LivolsiSource :
- Hemodialysis International [ 1492-7535 ] ; 2004-01.
Abstract
There is a growing interest in the use of daily dialysis since long‐term experiences have shown good results. Online hemodiafiltration (OL‐HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL‐HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL‐HDF at least during the last 6 months, were switched to D‐OL‐HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D‐OL‐HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D‐OL‐HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. Is it ethical to reserve this dialysis modality only to selected children?
Url:
DOI: 10.1111/j.1492-7535.2004.0085by.x
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Fischbach</name><affiliation><mods:affiliation>Dialysis Children's Unit, Strasbourg, France.</mods:affiliation></affiliation></author><author><name sortKey="Terzic, J" sort="Terzic, J" uniqKey="Terzic J" first="J." last="Terzic">J. Terzic</name><affiliation><mods:affiliation>Dialysis Children's Unit, Strasbourg, France.</mods:affiliation></affiliation></author><author><name sortKey="Laugel, V" sort="Laugel, V" uniqKey="Laugel V" first="V." last="Laugel">V. Laugel</name><affiliation><mods:affiliation>Dialysis Children's Unit, Strasbourg, France.</mods:affiliation></affiliation></author><author><name sortKey="Helms, P" sort="Helms, P" uniqKey="Helms P" first="P." last="Helms">P. Helms</name><affiliation><mods:affiliation>Dialysis Children's Unit, Strasbourg, France.</mods:affiliation></affiliation></author><author><name sortKey="Livolsi, A" sort="Livolsi, A" uniqKey="Livolsi A" first="A." last="Livolsi">A. Livolsi</name><affiliation><mods:affiliation>Dialysis Children's Unit, Strasbourg, France.</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">Hemodialysis International</title><title level="j" type="alt">HEMODIALYSIS INTERNATIONAL</title><idno type="ISSN">1492-7535</idno><idno type="eISSN">1542-4758</idno><imprint><biblScope unit="vol">8</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="107">107</biblScope><biblScope unit="page" to="107">107</biblScope><biblScope unit="page-count">100</biblScope><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK; Malden, USA</pubPlace><date type="published" when="2004-01">2004-01</date></imprint><idno type="ISSN">1492-7535</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1492-7535</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">There is a growing interest in the use of daily dialysis since long‐term experiences have shown good results. Online hemodiafiltration (OL‐HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL‐HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL‐HDF at least during the last 6 months, were switched to D‐OL‐HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D‐OL‐HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D‐OL‐HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. 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pressure</json:string><json:string>syndrome</json:string><json:string>ontario</json:string><json:string>albumin</json:string><json:string>clearance</json:string><json:string>mortality</json:string><json:string>complication</json:string><json:string>hemoglobin</json:string><json:string>diabetes</json:string><json:string>infection</json:string></teeft></keywords><author><json:item><name>M. Fischbach</name><affiliations><json:string>Dialysis Children's Unit, Strasbourg, France.</json:string></affiliations></json:item><json:item><name>J. Terzic</name><affiliations><json:string>Dialysis Children's Unit, Strasbourg, France.</json:string></affiliations></json:item><json:item><name>V. Laugel</name><affiliations><json:string>Dialysis Children's Unit, Strasbourg, France.</json:string></affiliations></json:item><json:item><name>P. Helms</name><affiliations><json:string>Dialysis Children's Unit, Strasbourg, France.</json:string></affiliations></json:item><json:item><name>A. Livolsi</name><affiliations><json:string>Dialysis Children's Unit, Strasbourg, France.</json:string></affiliations></json:item></author><articleId><json:string>HDI085BY</json:string></articleId><arkIstex>ark:/67375/WNG-ZWQG4VTF-6</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>abstract</json:string></originalGenre><abstract>There is a growing interest in the use of daily dialysis since long‐term experiences have shown good results. Online hemodiafiltration (OL‐HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL‐HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL‐HDF at least during the last 6 months, were switched to D‐OL‐HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D‐OL‐HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D‐OL‐HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. Is it ethical to reserve this dialysis modality only to selected children?</abstract><qualityIndicators><score>10</score><pdfWordCount>24342</pdfWordCount><pdfCharCount>151874</pdfCharCount><pdfVersion>1.4</pdfVersion><pdfPageCount>33</pdfPageCount><pdfPageSize>595 x 782 pts</pdfPageSize><pdfWordsPerPage>738</pdfWordsPerPage><pdfText>true</pdfText><refBibsNative>false</refBibsNative><abstractWordCount>277</abstractWordCount><abstractCharCount>1860</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?</title><genre><json:string>abstract</json:string></genre><host><title>Hemodialysis International</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1542-4758</json:string></doi><issn><json:string>1492-7535</json:string></issn><eissn><json:string>1542-4758</json:string></eissn><publisherId><json:string>HDI</json:string></publisherId><volume>8</volume><issue>1</issue><pages><first>107</first><last>107</last><total>100</total></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>8/1/03</json:string><json:string>2/8/03</json:string><json:string>between May 2002 and September 2003</json:string><json:string>2001</json:string><json:string>1993</json:string><json:string>1971</json:string><json:string>1998</json:string><json:string>6050</json:string><json:string>1203</json:string><json:string>1999</json:string><json:string>4445</json:string><json:string>1990</json:string><json:string>2/10/03</json:string><json:string>2003</json:string><json:string>1995</json:string><json:string>2/3/03</json:string><json:string>2001 and 6/2003</json:string><json:string>1087</json:string><json:string>1117</json:string><json:string>2004</json:string><json:string>3706</json:string></date><geogName></geogName><orgName><json:string>University of Toronto</json:string><json:string>Loyola University</json:string><json:string>Department of Internal Medicine</json:string><json:string>Genpharm</json:string><json:string>Saint Michael’s Hospital, Toronto, Ontario, Canada</json:string><json:string>Michael’s Hospital, Toronto, Ontario, Canada</json:string><json:string>Department of Internal 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Greece</json:string><json:string>Consiglio</json:string><json:string>The Jos University</json:string><json:string>University of Texas Health Science Center, San Antonio</json:string><json:string>Department of Clinical Science, Karolinska Institutet, Huddinge University Hospital, Stockholm, Sweden</json:string><json:string>University Faculty of Medicine</json:string><json:string>Virginia Commonwealth University</json:string><json:string>Medical University</json:string><json:string>Society for Hemodialysis</json:string><json:string>Shonan Institute of Technology, Fujisawa</json:string><json:string>Department of Chemical Pathology</json:string><json:string>Louisiana State University</json:string><json:string>Department of Pediatric Nephrology, University Children</json:string><json:string>Department of Nephrology, Hospital Universitario</json:string><json:string>University Hospitals of Cleveland</json:string><json:string>Division of Molecular Medicine</json:string><json:string>Department of Internal Medicine, University of Turin, Turin, Italy</json:string><json:string>Luke’s Hospital, Chester</json:string><json:string>Hospital for Sick Children, Toronto, Ontario, Canada</json:string><json:string>Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Gyeonggi, Korea</json:string><json:string>Aksys Ltd.</json:string><json:string>Kingston General Hospital, Kingston, Ontario, Canada</json:string><json:string>Department of Biochemistry</json:string><json:string>Turkey Vascular</json:string><json:string>Mercy Hospital, Kansas City, MO</json:string><json:string>Department of Internal Medicine, The Catholic University of Korea, Seoul, Korea</json:string><json:string>Hemodialysis Hemodialysis International</json:string><json:string>Lamentin Hospital, Martinique</json:string><json:string>Taiwan HD</json:string><json:string>Institute of Medical Science, Tokai University, Isehara, Japan</json:string><json:string>Department of Nephrology, 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Ryu</json:string><json:string>S. Paydas</json:string><json:string>J. Samik</json:string><json:string>V.U. Dreizin</json:string><json:string>C.W. Yang</json:string><json:string>D.S. Han</json:string><json:string>S. Ferenczi</json:string><json:string>D. Hobbs</json:string><json:string>L. Flynn</json:string><json:string>J. Hynes</json:string><json:string>J. Terzic</json:string><json:string>M.F. Weiss</json:string><json:string>D.S. Lirenman</json:string><json:string>E.J. Choi</json:string><json:string>V. Methods</json:string><json:string>A. Jeantet</json:string><json:string>R. Halker</json:string><json:string>S. Yang</json:string><json:string>R. Carson</json:string><json:string>S. Cetiner</json:string><json:string>V. Liakopoulos</json:string><json:string>S.J. Oh</json:string><json:string>M. Velizatova</json:string><json:string>B.A. Warady</json:string><json:string>T. Gehr</json:string><json:string>C. Bainey</json:string><json:string>Y.S. Chang</json:string><json:string>Y.O. Kim</json:string><json:string>P. Karabatakis</json:string><json:string>Y.S. Kim</json:string><json:string>L.L. Jones</json:string><json:string>D.L. Campbell</json:string><json:string>R.H. Glew</json:string><json:string>A. Takesawa</json:string><json:string>S.H. Lee</json:string><json:string>C.T. Chan</json:string><json:string>T. Drossert</json:string><json:string>E.I. Agaba</json:string><json:string>K. Sakurai</json:string><json:string>S. Blankshaen</json:string><json:string>R.A. Tzamaloukas</json:string><json:string>S. Zarogiannis</json:string><json:string>K. McPhail</json:string><json:string>S. Hadjiev</json:string><json:string>E. Weinhandl</json:string><json:string>L. Paille</json:string><json:string>A.M. Belechri</json:string><json:string>P.F. Hoyer</json:string><json:string>T.S. Ing</json:string><json:string>L. Cantey</json:string><json:string>A.J. Collins</json:string><json:string>T. Fuji</json:string><json:string>M. Kreuzer</json:string><json:string>R. Nemec</json:string><json:string>M. Philipneri</json:string><json:string>J. Szegedi</json:string><json:string>B. Young</json:string><json:string>Z.J. Twardowski</json:string><json:string>A. Papagianni</json:string><json:string>N.K. Atray</json:string><json:string>G. Barril</json:string><json:string>V. Papazov</json:string><json:string>M. Burdese</json:string><json:string>M.S. Jackson</json:string><json:string>M.Y. Hassan</json:string><json:string>M. Gellens</json:string><json:string>I. El-Esper</json:string><json:string>U.S.A. Nephrogenic</json:string><json:string>M. Jayoma</json:string><json:string>E.A. Iliescu</json:string><json:string>E. Mitsopoulos</json:string><json:string>J. Traeger</json:string><json:string>L.A. Douglas</json:string><json:string>H.A. Maiza</json:string><json:string>B. Lindholm</json:string><json:string>U.S.A. Background</json:string><json:string>M.O. Spencer</json:string><json:string>A. Kroeker</json:string><json:string>N. Herian</json:string><json:string>A.C. Yamashita</json:string><json:string>A. Livolsi</json:string><json:string>C.M. Kjellstrand</json:string><json:string>C. Li</json:string><json:string>V. Carreno</json:string><json:string>P. Hann</json:string><json:string>T. Masuda</json:string><json:string>Hemodialysis</json:string><json:string>T. Eisen</json:string><json:string>G. Maranon</json:string><json:string>The</json:string><json:string>E.W. Kang</json:string><json:string>Have</json:string><json:string>I. Quality</json:string><json:string>U. Vester</json:string><json:string>J. Tsai</json:string><json:string>F.B. Atac</json:string><json:string>P. Caro</json:string><json:string>M. Ragab</json:string><json:string>R. Galland</json:string><json:string>E. Delawari</json:string><json:string>Anecdotal</json:string><json:string>P. Erhard</json:string><json:string>I. Kiss</json:string><json:string>J.A. Miller</json:string><json:string>Y. Sato</json:string><json:string>S. Sezer</json:string><json:string>L. Haglund</json:string><json:string>C. Carmicheal</json:string><json:string>E.K. Zervou</json:string><json:string>D. Hines</json:string><json:string>A. Jones</json:string><json:string>R.Z. Ismagilov</json:string><json:string>H. Vos</json:string><json:string>F. Boitte</json:string><json:string>T. Ing</json:string><json:string>S. Chaudhury</json:string><json:string>U.S.A. Central</json:string><json:string>G. Zabioglou</json:string><json:string>S.K. Banerjee</json:string><json:string>J. Bartolome</json:string><json:string>Any Relationship</json:string><json:string>E. Gonzalez</json:string><json:string>G.B. Piccoli</json:string><json:string>O.M. Cairoli</json:string><json:string>Nephrology</json:string><json:string>M. Shenouda</json:string><json:string>R.M. Hossain</json:string><json:string>M. Fischbach</json:string><json:string>K. Larson</json:string><json:string>A. Bruchfeld</json:string><json:string>A. Yoshimoto</json:string><json:string>V. Sreenarasimhaiah</json:string><json:string>F. Tio</json:string><json:string>P. Stenvinkel</json:string><json:string>M. Imran</json:string><json:string>Y. Chen</json:string><json:string>G. Wagner</json:string><json:string>H.M. Cho</json:string><json:string>Z. Arat</json:string><json:string>S. Yamasaki</json:string><json:string>H. Okada</json:string><json:string>H.S. Chae</json:string><json:string>N. Kojcheva</json:string><json:string>G. Kyriakopoulos</json:string><json:string>M. Yoshikawa</json:string><json:string>M.D. Lee</json:string><json:string>A. Verhallen</json:string><json:string>N. Islam</json:string><json:string>M.P. Kooistra</json:string><json:string>A. Grundy</json:string><json:string>K. Ako</json:string><json:string>L. Troidle</json:string><json:string>S.L. Johnson</json:string><json:string>A. Joseph</json:string><json:string>To</json:string><json:string>J.I. Kim</json:string><json:string>U.S.A. Introduction</json:string><json:string>A.S. Azhitaeva</json:string><json:string>S.J.A.M. Stokvis</json:string><json:string>L. Extracorporeal</json:string><json:string>S.A. Yoon</json:string><json:string>Day Length</json:string><json:string>S. Gorogh</json:string><json:string>D. Kirmizis</json:string><json:string>M.A. Pachaly</json:string><json:string>T. Nakai</json:string><json:string>S. Chiang</json:string><json:string>W.S. Andrews</json:string><json:string>P. Kiriklidou</json:string><json:string>A. Stein</json:string><json:string>K.H. Choi</json:string><json:string>H. Nemoto</json:string><json:string>D.J. Vanderjagt</json:string><json:string>G.N. Dalekos</json:string><json:string>S.S. Haqqie</json:string><json:string>F. Dapena</json:string><json:string>G. Soragna</json:string><json:string>F. Coronel</json:string><json:string>P. Helms</json:string><json:string>L. Wales</json:string><json:string>C. Adams</json:string><json:string>Blood Bank</json:string><json:string>J.E. Carter</json:string><json:string>S.W. Kang</json:string><json:string>P. Sanz</json:string><json:string>E. Hryciw</json:string><json:string>R.N. Foley</json:string><json:string>Y.M. Ku</json:string><json:string>S. Peng</json:string><json:string>M. Gai</json:string><json:string>T.J. Vachharajani</json:string><json:string>M.C. Riella</json:string><json:string>S.B. Chebrolu</json:string><json:string>J. Campbell</json:string><json:string>M.J. Thomas</json:string><json:string>A.M. Verhallen</json:string><json:string>R. Martinez</json:string><json:string>Doppler</json:string><json:string>Y.S. Shin</json:string><json:string>C. Holloman</json:string><json:string>C.A. Solid</json:string><json:string>H.C. Song</json:string><json:string>R. Selgas</json:string><json:string>I. Sakaji</json:string><json:string>M. Agraharkar</json:string><json:string>A. Rico</json:string><json:string>A. Rahman</json:string><json:string>J. Buss</json:string><json:string>S. Islam</json:string><json:string>A. Saito</json:string><json:string>B. Borbas</json:string><json:string>J. Valente</json:string><json:string>D. Shore</json:string><json:string>A. Bidani</json:string><json:string>Ht</json:string><json:string>E. Tutal</json:string><json:string>N. Kanbara</json:string><json:string>T. Suzuki</json:string><json:string>L. Renner</json:string><json:string>T. McComb</json:string><json:string>A. Zolota</json:string><json:string>S.W. McConnell</json:string><json:string>C. Rizos</json:string><json:string>Y. Kanno</json:string><json:string>G. Seydaoglu</json:string><json:string>M. Oadri</json:string><json:string>D. Motta</json:string><json:string>M. Salomone</json:string><json:string>D.C. Holland</json:string><json:string>Val Val</json:string><json:string>Elevation</json:string><json:string>K. Masuhara</json:string><json:string>M.P. Ruiz</json:string><json:string>A. Pierratos</json:string><json:string>S. Dobrev</json:string><json:string>M.F. Pipkin</json:string><json:string>El Pilar</json:string><json:string>H.Y. Choi</json:string><json:string>C.R. Blagg</json:string><json:string>D.T. Gilbertson</json:string><json:string>U. Princesa</json:string><json:string>R.M. Lindsay</json:string><json:string>E. Alexopoulos</json:string><json:string>U.S.A. Methods</json:string><json:string>C. Siegel</json:string><json:string>K. Chiang</json:string><json:string>Factor</json:string></persName><placeName><json:string>TX</json:string><json:string>U.S.</json:string><json:string>Menlo Park</json:string><json:string>Leiden</json:string><json:string>IL</json:string><json:string>MS</json:string><json:string>Utrecht</json:string><json:string>Terashima</json:string><json:string>Ankara</json:string><json:string>Columbia</json:string><json:string>Germany</json:string><json:string>Greece</json:string><json:string>Shreveport</json:string><json:string>Mineshima</json:string><json:string>Edmonton</json:string><json:string>NY</json:string><json:string>Dallas</json:string><json:string>Bangladesh</json:string><json:string>Korea</json:string><json:string>Seoul</json:string><json:string>Brazil</json:string><json:string>Spokane</json:string><json:string>Albany</json:string><json:string>Dhaka</json:string><json:string>Turkey</json:string><json:string>Richmond</json:string><json:string>Matsushima</json:string><json:string>Taiwan</json:string><json:string>Canada</json:string><json:string>LA</json:string><json:string>VA</json:string><json:string>Lynchburg</json:string><json:string>American</json:string><json:string>Madrid</json:string><json:string>HEL</json:string><json:string>Lincolnshire</json:string><json:string>U.S.</json:string><json:string>Kazakhstan</json:string><json:string>Seattle</json:string><json:string>MO</json:string><json:string>Jackson</json:string><json:string>China</json:string><json:string>Bulgaria</json:string><json:string>Toronto</json:string><json:string>Galveston</json:string><json:string>Japan</json:string><json:string>Strasbourg</json:string><json:string>America</json:string><json:string>Nigeria</json:string><json:string>Brussels</json:string><json:string>EPS</json:string><json:string>Tokyo</json:string><json:string>Chicago</json:string><json:string>CA</json:string><json:string>Palm Beach</json:string><json:string>U.S.</json:string><json:string>Saint Michael</json:string><json:string>France</json:string><json:string>Essen</json:string><json:string>WA</json:string><json:string>Cleveland</json:string><json:string>Spain</json:string><json:string>Lyon</json:string><json:string>Belgium</json:string><json:string>OH</json:string><json:string>Netherlands</json:string><json:string>Osaka</json:string></placeName><ref_url></ref_url><ref_bibl><json:string>second session, 4390</json:string><json:string>April 2001</json:string><json:string>second session, 6167</json:string><json:string>third session, 4775</json:string><json:string>Devereaux et al.</json:string><json:string>first session, 4477</json:string><json:string>third session, 5178</json:string><json:string>second session, 4167</json:string><json:string>first session, 5443</json:string><json:string>first session, 4633</json:string><json:string>third session, 5078</json:string><json:string>March 2003</json:string><json:string>September 1997</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-ZWQG4VTF-6</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - urology & nephrology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - urology & nephrology</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Nephrology</json:string><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Hematology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2004</publicationDate><copyrightDate>2004</copyrightDate><doi><json:string>10.1111/j.1492-7535.2004.0085by.x</json:string></doi><id>8DE91A6BC2F29BB2F586E6BD81EB4DD4ED663456</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-ZWQG4VTF-6/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-ZWQG4VTF-6/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/WNG-ZWQG4VTF-6/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?</title><title level="a" type="short">Abstracts</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Science Inc</publisher><pubPlace>Oxford, UK; 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Online hemodiafiltration (OL‐HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL‐HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL‐HDF at least during the last 6 months, were switched to D‐OL‐HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D‐OL‐HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D‐OL‐HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. 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