Optimizing the Hemodialysis Prescription and Assessment of Dialysis Adequacy in Children.

Hemodialysis (HD) is an important modality of kidney replacement therapy in children with kidney failure. Vascular access in children can be challenging. Although central venous catheters are commonly used, arteriovenous fistulae provide an effective and sustainable access for HD. To provide optimal HD, the prescription should be tailored to each child. The size of the dialyzer and tubings and the extracorporeal circuit volume must be adapted to the size and weight of the child. Dialysate composition and duration of dialysis are altered to suit the metabolic profile, and the ultrafiltration volume is decided based on the hemodynamic status and interdialytic weight gain. To ensure that optimal dialysis is provided, parameters of dialysis adequacy are measured at regular intervals. Although clearance of urea (Kt/V) is the recommended measure of dialysis adequacy, it is important to assess growth, nutrition, blood pressure control, metabolic profile, and quality of life as measures of adequate dialysis in children. [ABSTRACT FROM AUTHOR]