Table 6.

Hemodialysis prescription for children: adequate, before optimum

- Dialysis modality should enable achievement of blood pressure control (without antihypertensive medications for most children), normal myocardial morphology and function

- Dialysis dose prescription should not only be an urea dialysis dose. Removal of the other uremic toxins should be considered, not only middle molecules but overall phosphate

- Dialysis frequency and duration must be adjusted to the tolerance of ultrafiltration to reach the dry weight. Ultrafiltration rate should not exceed 1.5±0.5% of body weight per hour (in theory no more than 5% BW loss per whole session ). Blood volume (hematocrite) guided ultrafiltration secure

- A regular diet survey is essential to maintain adequate protein and calorie intakes. Urea kinetic assessment enables not only urea dialysis dose calculation, i.e. Kt/V, but also estimation of protein intake by use of the PCRn calculation (protein catabolic rate). Fasting to enable a short duration three times a week dialysis schedule is inadequate care management

- Too fast ultrafiltration can induce hypotension and cramps during dialysis, usually during the second half time session, and fatigue and/or hang over after dialysis

- A small solute, e.g. urea, clearance which is too high is a factor of disequilibrium syndrome occurring during dialysis, usually after the first half/or one hour session time with headache, even seizures, nausea, vomiting, sleepiness or a hypertensive tendency with a narrow range between systolic and diastolic pressure values. Symptoms usually disappear a few hours after the end of the dialysis