Indications for Dialysis:
- Fluid overload with pulmonary edema and/or respiratory failure
- Uremia with encephalopathy or bleeding
- Metabolic derangements: hyperkalemia, acidosis, hyperphosphatemia
- Intoxications: lithium, methyl alcohol, salicylate
- Inborn errors of metabolism: urea cycle defects
- Nutritional support
Complications of Dialysis by Modality:
All
- Volume Depletion
- Removal of drugs and nutrients
- Electrolyte imbalance
- Access infection
- Access malfunction (leak / hemorrhage, obstruction / thrombosis
Peritoneal Dialysis
- Hyperglycemia
- Hydrothorax
- Infection (exit site, peritonitis)
- Hypothermia
- Hyponatremia
Hemodialysis
- Disequilebrium syndrome
- Membrane bioincompatibility
Continuous Hemofiltration
- Hyperglycemia (if peritoneal dialysate used)
- Hypothermia
- Membrane bioincompatibility
Suggested Modality of Choice in Pediatric ARF
| Goal of Dialysis |
Hemodynamic Status |
Modality |
| Ultrafiltration |
Normotensive |
Intermittent hemodialysis (with isolated ultrafiltration) |
|
Hypotensive |
Continuous hemofiltration or peritoneal dialysis |
| Urea clearance |
Normotensive |
Intermittent hemodialysis or peritoneal dialysis |
|
Hypotensive |
Continuous hemofiltration or peritoneal dialysis |
| Treatment of hyperkalemia |
Either normotensive or hypotensive |
Intermittent hemodialysis |
| Correction of metabolic acidosis |
Normotensive |
Any |
|
Hypotensive |
Continuous hemofiltration or peritoneal dialysis |
| Treatment of hyperphosphatemia |
Either normotensive or hypotensive |
Any; continuous hemofiltration possibly superior |
Flynn JT Pediatr Nephrol (2002) 17:61-69
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