Rapid accelerated hemodialysis in children with end-stage renal disease: a randomized clinical trial

In rapid accelerated hemodialysis (R-AHD),blood partially recirculates from the venous (outflow) to the arterial (inflow) line through a recirculation line (R) to selectively increase the filter blood flow rate (BFR). R-AHD PR uses two blood pump segments at the patient segment of the arterial line and at (R). To determine the effectiveness of R-AHD with regard to increasing anticoagulation and dialysis efficiency,we studied ten children with end-stage renal disease in two stages: stage 1 with 10 routine heparin R-AHD,then 10 half-dose heparin R-AHD,then 145 routine heparin R-AHD sessions for 1 month and then routine heparin double needle hemodialysis (DNHD) for one month (control). In stage 2,we dialyzed the patients with 10 routine heparin-mixed AHD PR and DNHD sessions,then eight low-dose heparin R-AHD PR sessions,then one of the children with 10 no-heparin R-AHD PR sessions and then 10 routine heparin DNHD sessions (control). Signs of blood clotting and dialysis efficiency were monitored. Blood clots appeared in four out of 165 R-AHD 0 (one pump circuit) sessions but in none of the 28 R-AHD PR sessions. In stage 1,the mean urea reduction rate was 0.60,0.60 and 0.70 for the R-AHD protocols,compared with 0.71 for the control (P 0.05). In stage 2,the arterial blood urea nitrogen was reduced by 0.66 ± 0.15 after an R-AHD PR period,compared with 0.79 ± 0.18 after a DNHD period (P = 0.059). In conclusion,R-AHD PR allowed successful low heparin and no heparin hemodialysis in children without increasing the patients BFR. However,the technique did not increase the efficiency of dialysis.