Dose of dialysis based on body surface area is markedly less in younger children than in older adolescents.
| Autor: | Daugirdas JT; University of Illinois at Chicago, 820 S. Wood Street, N/C 793, Chicago, IL 60612, USA. jtdaugir@uic.edu, Hanna MG, Becker-Cohen R, Langman CB |
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| Jazyk: | angličtina |
| Zdroj: | Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2010 May; Vol. 5 (5), pp. 821-7. Date of Electronic Publication: 2010 Mar 18. |
| DOI: | 10.2215/CJN.08171109 |
| Abstrakt: | Unlabelled: BACKGROUND AND OBSERVATIONS: The current denominator for dosing dialysis is the urea distribution volume (V). Normalizing Kt/V to body surface area (S) has been proposed, but the implications of doing this in children have not been examined. Design, Setting, Participants, & Measurements: Dialysis dose given to children and adolescents was calculated in terms of conventional V-based scaling and surface-area-normalized standard Kt/V (SAN-stdKt/V) calculated as stdKt/V x (Vant/S)/17.5, where Vant was an anthropometric estimate of V calculated using the Morgenstern equation. Formal 2-pool modeling was used to compute all dialysis adequacy outputs. Results: In 34 children (11 girls, 23 boys) dialyzed 3 times a week, age range 1.4 to 18 years, the mean delivered equilibrated Kt/V (eKt/V) was 1.40, and the mean stdKt/V was 2.49, both of which tended to be higher in younger children. The ratio of Vant to S was 15.6 +/- 2.69 and was strongly associated with age between ages 2 and 16. SAN-stdKt/V averaged 2.21 and was strongly correlated with age between ages 2 and 16. If one considers a desired target for SAN-stdKt/V to be 2.45, all children less than 10 years of age were below target, despite having relatively high values of eKt/V and stdKt/V. Conclusions: If a surface-area-based denominator were to be adopted for dialysis dosing, most children under 10 years of age would receive markedly less dialysis than adolescent patients and would require 6- to 8-hour hemodialysis sessions or, for the youngest children, treatments given more frequently than 3 times/wk. |
| Databáze: | MEDLINE |
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