Rapid accelerated hemodialysis in children with end-stage renal disease : a randomized clinical trial

Abstract EN

In rapid accelerated hemodialysis (R-AHD), blood partially recirculates from the venous (outflow) to the arterial (inflow) line through a recirculation line (R) to selectively increase the filter blood flow rate (BFR).

R-AHDPR uses two blood pump segments at the patient segment of the arterial line and at (R).

To determine the effectiveness of R-AHD with regard to increasing anticoagulation and dialysis efficiency, we studied ten children with end-stage renal disease in two stages : stage 1 with 10 routine heparin R-AHD, then 10 half-dose heparin R-AHD, then 145 routine heparin R-AHD sessions for 1 month and then routine heparin double needle hemodialysis (DNHD) for one month (control).

In stage 2, we dialyzed the patients with 10 routine heparin-mixed AHDPR and DNHD sessions, then eight low-dose heparin R-AHDPR ” sessions, then one of the children with 10 no-heparin R-AHDPR sessions and then 10 routine heparin DNHD sessions ” (control).

Signs of blood clotting and dialysis efficiency were monitored.

Blood clots appeared in four out of 165 R-AHD0 (one pump circuit) sessions but in none of the 28 R-AHDPR sessions.

In stage 1, the mean urea reduction rate was 0.60, 0.60 and 0.70 for the R-AHD protocols, compared with 0.71 for the control (P > 0.05).

In stage 2, the arterial blood urea nitrogen was reduced by 0.66 ± 0.15 after an R-AHDPR period, compared with 0.79 ± 0.18 after a DNHD period (P = 0.059).

In conclusion, R-AHDPR allowed successful low heparin and no heparin hemodialysis in children without increasing the patients’ BFR.

However, the technique did not increase the efficiency of dialysis.