Blood Volume Monitoring to Assess Dry Weight in Pediatric Chronic Hemodialysis Patients.

OBJECTIVE: Volume overload from an incorrect assessment of dry weight leads to cardiovascular diseases in chronic hemodialysis patients. Dry weight assessment in pediatric is difficult for a number of reasons including growth. Blood volume monitoring (BVM) has been proposed as an accurate method of estimating dry weight in adult. However, there is very scant data regarding B VM assessment in pediatric. Therefore, the authors conducted a study to compare dry weight, postdialytic body weight, predialytic blood pressure, intradialytic blood pressure, and intra dialytic symptoms between clinical adjustment and B VM method. MATERIAL AND METHOD: In pediatric chronic hemodialysis patient, B VM was performed to guide ultrafiltration to adjust dry weight compared with clinical adjustment. Data including dry weight, postdialytic body weight, predialytic blood pressure, intradialytic hypotension, and intradialytic symptoms were analyzed over each 1-month period of treatment course. RESULTS: Ten patients (5 males/5 females, age 16.55 ± 2.49 years) were enrolled. Comparing clinical adjustment to assess dry weight with BVM, there were no differences in dry weight (38.38 ± 7.43 vs. 38.12 ± 7.58 kg) and postdialytic body weight (38.54 ± 7.61 vs. 38.23 ± 7.35) of both methods. Dry weight adjusted by clinical adjustment trends to higher than by BVM (0.14 ± 0.46 vs. -0.26 ± 0.57 kg). There is also no difference between predialytic blood pressure of both methods. There is no intradialytic hypotension during the study period. However, intradialytic symptoms in clinical adjustment diy weight is more frequent than B VM method, especially thirst. CONCLUSION: The use of BVM tends to decrease dy weight in pediatric chronic hemodialysis patients. Even though, no difference in predialytic blood pressure and intradialytic hypotension. BVM to assess dry weight reduces abnormal intradialytic symptoms, especially thirst. Sofar there is no gold standard to access the accurate dry weight in children.

Electrolyte disturbances and abnormal urine analysis in children with dengue infection.

Serum electrolytes and urine analysis results were retrospectively reviewed in children with either dengue fever (DF) or dengue hemorrhagic fever (DHF). Children who had positive serology for dengue infection and serum electrolytes determined before starting intravenous fluid were included in the study. During the years 2004-2007, 73 DF patients, age 9.29 +/- 3.62 years, and 77 DHF patients, age 10.04 +/- 3.64 years were enrolled in the study. The patients were admitted to the hospital on average on days 4.12 +/- 1.1 and 4.25 +/- 1.4 of febrile illness for DF and DHF, respectively. The prevalence of hyponatremia in patients with DF was 61% and DHF was 72% (p = 0.149). The mean serum sodium levels in patients with DF and DHF were 133.5 +/- 3.52 and 133.5 +/- 3.20 mEq/l (p = 0.938), respectively. The prevalence of hyponatremia in patients with mild (grade I), moderate (grade II) and severe (grade III-IV) DHF were 70, 77, and 78% (p = 0.729), respectively, and the mean serum sodium levels were 134.1 +/- 3.05, 132.9 +/- 3.33, and 132.5 +/- 3.28 (p = 0.189), respectively. The prevalence of hypokalemia in patients with DF was 14% and 17% in patients with DHF (p = 0.588). A high urine specific gravity reflecting dehydration was found in 63% of patients with DF and 60% of patients with DHF (p = 0.77). The prevalences of hematuria in patients with DF and DHF were 18% and 27% (p = 0.182), respectively and proteinuria were 15% and 27% (p = 0.072), respectively. The prevalences of hematuria and proteinuria were not different among patients with mild, moderate and severe DHF. No patients had gross hematuria or developed acute renal failure requiring dialysis. Mild hyponatremia is a common electrolyte disturbance and renal involvement is mild in patients with DF and DHF.

Rare F311L CFTR gene mutation in a child presented with recurrent electrolyte abnormalities and metabolic alkalosis: case report.

Delta F508 mutation is recognized as the most common genotype of cystic fibrosis (CF) however, there are small numbers of CF patients having Delta F508/F311L. In the present study, the authors report a 2-year-old Thai boy, originating from North India, presenting with recurrent episodes of febrile illness, hyponatremia, hypokalemia, and metabolic alkalosis since 4 months of age. He was transferred to our hospital for further investigation. Blood chemistry revealed the following serum electrolytes, sodium 122, potassium 3.69, chloride 79.7, and bicarbonate 33.8 mEq/L, and the following urine electrolytes, sodium < 10, potassium 45.7 and chloride < 10 mEq/L. After intravenous fluid administration, hyponatremia and metabolic alkalosis improved DNA sequencing analysis of his blood demonstrates compound mutation for Delta F508 and F311L in CFTR gene. In conclusion, the authors report a rare case of CF with Delta F508/F311L genotype presented with recurrent hyponatremia and metabolic alkalosis. Awareness of electrolyte abnormalities during febrile illness, proper genetic counseling, and long-term follow up are necessary in this patient.

Assessment of the different methods to predict equilibrated Kt/V in pediatric hemodialysis.

OBJECTIVES: To determine the degree of urea rebound in children on hemodialysis and compare the different calculation models for Kt/V. MATERIAL AND METHOD: The present study was performed in 50 hemodialysis sessions of 5 pediatric patients, 2 males and 3 females, aged 5-18 years, who had received hemodialysis for 7-48 months. Blood urea samples were obtained at the beginning, 70 minutes intradialysis, the end and every 10 minutes for 1 hour post- dialysis. The compared 6 different models of Kt/V were single pool, Daugirdas, equilibrated, rate equation, Maduell and Smye method. RESULTS: Urea rebound was found to be completed at least 60 minutes post- dialysis and mean percentage value was 30.68 +/- 9.663. Mean value of equilibrated Kt/V was 1.442 +/- 0.259 while that of single-pool Kt/V calculated by InC1/C2 was 1.705 +/- 0.252 leading to overestimation of Kt/V by 0.265 +/- 0.075. Mean value calculated by Daugirdas method was 2.083 +/- 0.336. Mean values obtained by rate equation, Maduell and Smye methods were 1.485 +/- 0.209, 1.442 +/- 0.209 and 1.379 +/- 0.343 which differed from equilibrated Kt/V by 0.086 +/- 0.058 (p = 0.002), 0.069 +/- 0.063 (p = 0.967) and 0.132 +/- 0.132 (p = 0.015), respectively. CONCLUSION: Urea rebound in pediatric patients is completed at least 60 minutes after cessasion of hemodialysis. Kt/V calculated from single-pool is not suitable for children. The Maduell model gives the best correlation to equilibrated Kt/V when compared to rate equation and Smye models.

Left ventricular hypertrophy and LV geometry in chronic dialysis children and adolescents.

Data from USRDS and Thai Renal Replacement Therapy revealed cardiovascular disease is a common cause of death in ESRD patients. Left ventricular hypertrophy (LVH) is one of the risk factors however there are few studies about this in chronic dialysis children. In the present study, the authors retrospectively reviewed the prevalence of LVH and variable parameters correlated with LVMI in chronic dialysis patients in Phramongkutklao Hospital. Eleven hemodialysis and three peritoneal dialysis patients, aged 12.1 +/- 5 years, were included. LVH was diagnosed by calculating LVMI from echocardiographic study. Clinical and laboratory data were reviewed to compare parameters between LVH and without LVH groups. Prevalence of LVH was 57%. In the LVH group, 7 patients had eccentric LVH and 1 patient had concentric LVH. LVH patients had significantly high systolic BP (SBP), diastolic BP (DBP), index of SBP and index of DBP. Blood pressure also had positive correlation and patients age had negative correlation with LVMI. In conclusion, high blood pressure is associated with left ventricular hypertrophy. Serial echocardiography and long term follow up should be done in this patient group to prevent cardiovascular morbidity and mortality.