Chapter 66

Hemodialysis

Evgenia Preka

Evgenia Preka

Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK

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Rukshana Shroff

Rukshana Shroff

Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK

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First published: 18 November 2022

Summary

This chapter presents the available studies and discusses current clinical recommendations for hemodialysis (HD) in children. Conventional HD is characterized by three main principles: diffusion convention, and ultrafiltration. Hemodiafiltration utilizes a combination of diffusive and convective solute transport through a highly permeable membrane, thereby achieving clearance of middle molecular weight solutes unlike conventional HD. The main advantage for children while being on home HD are growth, improved cardiovascular control, and improved quality of life. The type and size of catheter, the catheter site, and the technique for insertion need to be considered in order to choose the right catheter for each patient. The most serious complications of conventional HD are severe intradialytic hypotension, dialysis disequilibrium syndrome, air embolism, hemolysis during dialysis, and bacteremia. The most common complications in HD patients, and although mild can be extremely distressing for children, are cramps, headaches, nausea, and dialysis-related hypertension.

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