Fischbach Michel, Zaloszyc Ariane, Laetitia Higel, Menouer Soraya, Terzic Joelle
Nephrology Dialysis Transplantation Children's Unit, University Hospital Hautepierre, Strasbourg, France.
Hemodial Int. 2014 Oct;18 Suppl 1:S39-42. doi: 10.1111/hdi.12222.
The duration of chronic conventional dialysis is a risk factor in children, both in terms of growth retardation and cardiovascular morbidity and mortality. Therefore, we need to develop alternative strategies, such as preemptive kidney transplantation and/or more intensive dialysis prescription. Indeed, conventional hemodialysis could be improved in all children by the use of high permeable membrane and ultrapure dialysis fluids (having very low endotoxin levels); by the addition of a convective dialysis dose to the urea diffusion dialysis dose (Kt/Vurea), i.e., hemodiafiltration; moreover, by the preservation of cardiovascular morphology and function (optimized blood pressure control); and also by the prescription of more frequent/longer dialysis sessions.
长期进行传统透析对儿童来说是一个风险因素，无论是在生长发育迟缓方面，还是在心血管疾病的发病率和死亡率方面。因此，我们需要制定替代策略，如早期肾移植和/或更强化的透析方案。事实上，所有儿童的传统血液透析都可以通过使用高通透性膜和超纯透析液（内毒素水平极低）来改善；通过在尿素扩散透析剂量（Kt/Vurea）中增加对流透析剂量，即血液透析滤过；此外，通过保持心血管形态和功能（优化血压控制）；还可以通过安排更频繁/更长时间的透析疗程来改善。
