Great Ormond Street Hospital, London, UK.
University College London Institute of Child Health, London, UK.
Pediatr Nephrol. 2019 Feb;34(2):233-242. doi: 10.1007/s00467-018-3916-4. Epub 2018 Mar 9.
Dysregulation of intravascular fluid leads to chronic volume overload in children with end-stage kidney disease (ESKD). Sequelae include left ventricular hypertrophy and remodeling and impaired cardiac function. As a result, cardiovascular complications are the commonest cause of mortality in the pediatric dialysis population. The clinical need to optimize intravascular volume in children with ESKD is clear; however, its assessment and management is the most challenging aspect of the pediatric dialysis prescription. Minimizing chronic fluid overload is a key priority; however, excessive ultrafiltration is toxic to the myocardium and can precipitate intradialytic symptoms. This review outlines emerging objective techniques to enhance the assessment of fluid overload in children on dialysis and outlines evidence for current management strategies to address this clinical problem.
血管内液体失调导致终末期肾病（ESKD）患儿慢性容量超负荷。其后果包括左心室肥厚和重塑以及心脏功能受损。因此，心血管并发症是儿科透析人群中最常见的死亡原因。显然，临床需要优化 ESKD 患儿的血管内容量；然而，其评估和管理是儿科透析处方最具挑战性的方面。最大限度减少慢性液体超负荷是一个关键重点；然而，过度超滤对心肌有毒，并可能引发透析中症状。这篇综述概述了新兴的客观技术，以增强对透析患儿液体超负荷的评估，并概述了当前管理策略的证据，以解决这一临床问题。
