Chronic dialysis in the infant less than 1 year of age

Dialysis in the infant carries a mortality rate of 16%. Institution of dialysis may be the result of adequate nutritional intake, but avoidance of nutritional intake should never be seen as a way to prevent dialysis. Increased caloric intake, usually via enteral feeding tubes, is needed for optimal growth in the infant with end-stage renal disease (ESRD) in order to attain adequate nutrition with resulting good growth. “Renal” formulae may be constituted as dilute (as in the polyuric infant) or concentrated (as in the anuric infant) to fit the infants needs. Peritoneal dialysis (PD) is the usual mode of renal replacement therapy (97%), with access via a surgically placed cuffed catheter with attention to the placement of the exit site in order to avoid fecal or urinary contamination. PD volumes of 30–40 ml/kg per pass or 800–1,200 ml/m 2 per pass usually result in dialysis adequacy. Additional dietary sodium (3–5 mEq/kg per day) and protein (3–4 g/kg per day) are needed, due to sodium and protein losses in the dialysate. Protein losses are associated with significant infectious morbidity and nonresponsiveness to routine immunizations. Hemodialysis (HD) can be performed either as single- or dual-needle access that have minimal dead space (less then 2 ml) and recirculation rate (less then 5%). Attnetion to extracorporeal blood volume (<10% of intravascular volume), blood flow rates (3–5 ml/kg per min), heparinization (activated clotting times), ultrafiltration (ultrafiltration monitor), and temperature control is imperative during each treatment. Because infants' nutrition is mostly fluid, HD may be needed 4–6 days/week (especially in the oligoanuric infant) to avoid excessive volume overload between treatments. At the end of the treatment a slow blood return with minimal saline rinse is needed to avoid hemodynamic compromise. Infant dialysis, although technically challenging with a significant morbidity and mortality rate, can be safely carried out in the infant with ESRD but requires infant-specific equipment and trained personnel.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47836/1/467_2004_Article_BF00867678.pd

Enhanced ultrafiltration in rabbits with bicarbonate glycylglycine peritoneal dialysis solution

Objective: The aim of the study was to investigate net ultrafiltration (NUF) with a new bicarbonate glycylglycine (BiGG) peritoneal dialysis solution compared to the standard lactate (La) solution. Design: In six groups of 12 normal rabbits each we measured NUF after a 2-, 4-, and 6-hour peritoneal dialysis with a BiGG solution (pH 7.35) and a standard La solution (pH 5.5) of similar glucose, electrolyte, and osmolality formulation. Furthermore, we studied the phosphatidylcholine concentration in the effluent of the two solutions. Results: NUF volume was significantly greater with the BiGG rather than with the La solution by approximately 15% (p &lt; 0.05), 30% (p &lt; 0.01), and 40% (p &lt; 0.005) at 2, 4, and 6 hours, respectively. The glucose absorption rate was greater with the La solution than with the BiGG solution, but the difference was significant only at 2 hours (p &lt; 0.05). pH was increased in the La solution from its initial value of 5.5 to 7.18, 7.32, and 7.40 at 2, 4 and 6 hours, respectively, while it remained almost unchanged in the BiGG solution. Phosphatidylcholine (PC) in the peritoneal effluent was significantly higher in the BiGG solution in all instances (p &lt; 0.0001). Conclusion: It is concluded that the BiGG solution, which has a stable pH, 7.35, due to the potent buffering capacity of bicarbonate and glycylglycine, enhances peritoneal NUF by maintaining a higher osmotic gradient and retarding lymphatic absorption through an increase in PC concentration in the peritoneal cavity

Determination of spontaneous plasma fibrinolysis by a practical procedure

IN a recent review I analysed present aspects and principles of the various methods that are generally used for assessing the phenomenon of proteolysis in the blood. The extensive significance of in vitro determination of whole plasma spontaneous fibrinolysis, which expresses a more faithful and exact picture of the evolution of the fibrinolytic mechanism in the circulating blood, was emphasized1. © 1961 Nature Publishing Group

HEMODIALYSIS WITH A NEW SINGLE STABLE BICARBONATE DIALYSATE

A specified stable bicarbonate/glycylglycine dialysate for hemodialysis (HD) analogous to those introduced by us for continuous ambulatory peritoneal dialysis (CAPD) is described. HD with this single dialysate is simple, easy, safe and of reasonable cost. Results obtained from 6 HD patients proved its superiority against acetate dialysate. Bicarbonate/glycylglycine dialysate is also more stable, harmless and easier to use than bicarbonate dialysate prepared on-line