Melhem Nabil Z, Yadav Pallavi, Stronach Lynsey, Hothi Daljit K
Department of Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK, WC1N 3JH.
Pediatr Nephrol. 2015 Mar;30(3):533-6. doi: 10.1007/s00467-014-3032-z. Epub 2014 Dec 19.
Conventional thrice weekly haemodialysis (HD) provides adequate dialysis to prevent mortality, but morbidity is prevalent in both the paediatric and adult population. There has been growing interest in the potential of intensive dialysis regimes entering the realm of optimal dialysis, with superior health and quality of life outcomes.
CASE DIAGNOSIS/TREATMENT: We present the case of a 13-year-old girl who had bilateral nephrectomies as a result of bilateral Wilms tumors. In the third year of treatment with conventional HD, she presented with symptomatic progressive cardiac failure, presumably secondary to anthracycline-induced cardiomyopathy. Consequently, she was taken off the renal transplant list and became increasingly dependent on frequent in-centre dialysis sessions to manage her symptoms. Five months after switching to a frequent and extended home HD regime, we observed a tremendous improvement in her health and well-being, with complete reversal of her cardiac dysfunction.
Home HD is a practically viable option in children with severe cardiac dysfunction. Gentler, more intensive dialysis will draw out and improve the ureamic component of heart disease. This may translate into improved cardiac function.
传统的每周三次血液透析（HD）可提供足够的透析以预防死亡，但儿科和成人患者中并发症都很常见。人们越来越关注强化透析方案进入最佳透析领域的潜力，其具有更好的健康和生活质量结果。
病例诊断/治疗：我们报告一例13岁女孩的病例，该女孩因双侧肾母细胞瘤接受了双侧肾切除术。在接受传统血液透析治疗的第三年，她出现了有症状的进行性心力衰竭，可能继发于蒽环类药物引起的心肌病。因此，她被从肾移植名单中除名，并越来越依赖频繁的中心透析治疗来控制症状。在改用频繁且延长的家庭血液透析方案五个月后，我们观察到她的健康状况有了巨大改善，心脏功能障碍完全逆转。
家庭血液透析对于严重心脏功能障碍的儿童是一种切实可行的选择。更温和、更强化的透析将消除并改善心脏病的尿毒症成分。这可能转化为心脏功能的改善。
