Objective: To describe the effect of home nocturnal hemodialysis (NHD) in North American children. Study design: Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistu...
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Objective: To describe the effect of home nocturnal hemodialysis (NHD) in North American children. Study design: Four teenagers underwent NHD for 8 hours, 6 to 7 nights/week, using either central venous lines or fistulae for periods of 6 to 12 months. Blood flow approximated 200 mL/min, and dialysate flow was 300 mL/min; the dialysate contained potassium and phosphate. The procedure was remotely monitored. Results: The children had unrestricted diets and fluid allowance and did not require phosphate binders. Persistent relative hypotension developed in 2 of 4 children. Weekly Kt/V urea values were consistently >10; other biochemical measures varied. Quality of life and school attendance improved in 3 of 4 children. The workload and reported emotional burden of NHD was substantial. No significant complications occurred. Dialysate losses of calcium, phosphate and carnitine required supplementation. The annual cost per patient was $ 64,000 Canadian, which represented a 27% savings compared with thrice weekly in-center hemodialysis. Conclusions: NHD is feasible in selected children, allows free dietary and fluid intake, and improves patient wellbeing. The burden on the family is substantial, and NHD requires support of a dedicated multidisciplinary team.
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