Assessment of the different methods to predict equilibrated Kt/V in pediatric hemodialysis.

OBJECTIVES: To determine the degree of urea rebound in children on hemodialysis and compare the different calculation models for Kt/V. MATERIAL AND METHOD: The present study was performed in 50 hemodialysis sessions of 5 pediatric patients, 2 males and 3 females, aged 5-18 years, who had received hemodialysis for 7-48 months. Blood urea samples were obtained at the beginning, 70 minutes intradialysis, the end and every 10 minutes for 1 hour post- dialysis. The compared 6 different models of Kt/V were single pool, Daugirdas, equilibrated, rate equation, Maduell and Smye method. RESULTS: Urea rebound was found to be completed at least 60 minutes post- dialysis and mean percentage value was 30.68 +/- 9.663. Mean value of equilibrated Kt/V was 1.442 +/- 0.259 while that of single-pool Kt/V calculated by InC1/C2 was 1.705 +/- 0.252 leading to overestimation of Kt/V by 0.265 +/- 0.075. Mean value calculated by Daugirdas method was 2.083 +/- 0.336. Mean values obtained by rate equation, Maduell and Smye methods were 1.485 +/- 0.209, 1.442 +/- 0.209 and 1.379 +/- 0.343 which differed from equilibrated Kt/V by 0.086 +/- 0.058 (p = 0.002), 0.069 +/- 0.063 (p = 0.967) and 0.132 +/- 0.132 (p = 0.015), respectively. CONCLUSION: Urea rebound in pediatric patients is completed at least 60 minutes after cessasion of hemodialysis. Kt/V calculated from single-pool is not suitable for children. The Maduell model gives the best correlation to equilibrated Kt/V when compared to rate equation and Smye models.

Left ventricular hypertrophy and LV geometry in chronic dialysis children and adolescents.

Data from USRDS and Thai Renal Replacement Therapy revealed cardiovascular disease is a common cause of death in ESRD patients. Left ventricular hypertrophy (LVH) is one of the risk factors however there are few studies about this in chronic dialysis children. In the present study, the authors retrospectively reviewed the prevalence of LVH and variable parameters correlated with LVMI in chronic dialysis patients in Phramongkutklao Hospital. Eleven hemodialysis and three peritoneal dialysis patients, aged 12.1 +/- 5 years, were included. LVH was diagnosed by calculating LVMI from echocardiographic study. Clinical and laboratory data were reviewed to compare parameters between LVH and without LVH groups. Prevalence of LVH was 57%. In the LVH group, 7 patients had eccentric LVH and 1 patient had concentric LVH. LVH patients had significantly high systolic BP (SBP), diastolic BP (DBP), index of SBP and index of DBP. Blood pressure also had positive correlation and patients age had negative correlation with LVMI. In conclusion, high blood pressure is associated with left ventricular hypertrophy. Serial echocardiography and long term follow up should be done in this patient group to prevent cardiovascular morbidity and mortality.