Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis
Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis
复制标题
使用纽卡斯尔婴儿透析和超滤系统 (Nidus) 对体重 <8 公斤的婴儿进行血液透析：与腹膜透析和传统血液透析的比较
DOI：
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
H. Lambert
中科院分区：
文献类型：
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作者：
M. Coulthard;J. Crosier;C. Griffiths;Jon H. Smith;M. Drinnan;Michael Whitaker;R. Beckwith;J. Matthews;P. Flecknell;H. Lambert
为了比较纽卡斯尔婴儿透析和超滤系统(NIDUS)与腹膜透析(PD)和常规血液透析(HD)在体重为8公斤的婴儿中的疗效。方法我们比较了7只体重1-8公斤的仔猪的尿素、肌酐和磷酸盐的清除、超滤精度和安全性，在婴儿和没有其他治疗方法的婴儿中进行了计划的随机交叉试验，其中一些后来进入了常规血液透析。此外，出于人道主义考虑，9名婴儿接受了节育器的治疗：3名婴儿因PD失败，3名永久性肾功能衰竭婴儿后来转为传统HD。我们对10名体重在1.8至5.9公斤之间的婴儿进行了血液透析，时间为2,475小时，期间共进行了354次NIDUS治疗，没有发生任何临床重要事件，也没有检测到溶血。采用单腔血管通路，不需循环血液预充。在仔猪和婴儿中，使用NIDUS的尿素、肌酐和磷酸盐清除量约为1.5亿毫升/分钟至2.0亿毫升/分钟，并始终高于PD清除量，后者约为0.2百万毫升/分钟至0.8百万毫升/分钟(每种化学品的p ≤ 为0.0002)。超滤的精确度可以达到微升，但与钯的差异很大。结论NIDUS可以在儿科重症监护病房(PICU)和门诊间歇性HD中提供HD，而不需要为体重8公斤的婴儿预注血液，它产生的透析清除量比PD或传统HD更高，并提供比PD或传统HD更精确的超滤控制。
BackgroundTo compare the efficacy of the Newcastle infant dialysis and ultrafiltration system (Nidus) with peritoneal dialysis (PD) and conventional haemodialysis (HD) in infants weighing <8 kg.MethodsWe compared the urea, creatinine and phosphate clearances, the ultrafiltration precision, and the safety of the Nidus machine with PD in 7 piglets weighing 1–8 kg, in a planned randomised cross-over trial in babies, and in babies for whom no other therapy existed, some of whom later graduated to conventional HD.ResultsTwo babies entered the randomised trial; 1 recovered rapidly on PD, the other remained on the Nidus as PD failed. Additionally, 9 babies were treated on the Nidus on humanitarian grounds: 3 because of failed PD, and 3 with permanent kidney failure later converted to conventional HD. We haemodialysed 10 babies weighing between 1.8 and 5.9 kg for 2,475 h during 354 Nidus sessions without any clinically important incidents, and without detectable haemolysis. Single-lumen vascular access was used with no blood priming of circuits. The urea, creatinine and phosphate clearances using the Nidus were around 1.5 to 2.0 ml/min in piglets and babies, and were consistently higher than PD clearances, which ranged from about 0.2 to 0.8 ml/min (p ≤ 0.0002 for each chemical). Ultrafiltration was achieved to microlitre precision by the Nidus, but varied widely with PD. Fluid removal using conventional HD was imprecise and resulted in some hypovolaemic episodes requiring correction.ConclusionThe Nidus can provide HD in the Pediatric Intensive Care Unit (PICU) and outpatient intermittent HD without blood priming for babies weighing <8 kg, It generates higher dialysis clearances than PD, and delivers more precise ultrafiltration control than either PD or conventional HD.