الفهرس 
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Abstract
Hemodialysis (HD) is purifying the blood of a patient having nonfunctioning kidneys from waste products, it offers a higher rate of molecular transfer than peritoneal dialysis and other continuous renal replacement therapies and this qualifies it to be the most effective artificial renal support.
Although HD is not a curative measure, it alleviates many serious and sometimes lethal adverse outcomes of the chronic kidney disease (CKD). HD patients have a higher hospitalization rate and lower quality of life than the general population which in turn trigger another set of problems such as; anemia, CKD mineral bone disease, vascular access-related complications, and hypertension .
Dialysis outcomes are practice dependent, this has been confirmed in several studies demonstrating a better patient’s survival upon using a higher dialysis dose and different types of dialysis membranes.
The Dialysis Outcomes and Practice Patterns Study (DOPPS) offer up-to-date, comprehensive data on hemodialysis practice and patient outcomes all over the world. Inspiring several studies to identify practices that guarantee a longer survival and a better health-related quality of life (HR-QOL) for hemodialysis patients.
Unlike adults, children on HD need extra care as well as special evaluations and monitoring to ensure a successful HD. Thus, this study was designed to evaluate dialysis practice patterns in order to provide better care for children with end-stage renal disease (ESRD) on regular HD.
The aim of the present study was firstly to to evaluate the dialysis practice patterns and obtain data to improve care in the future in children with ESRD on regular hemodialysis.
This cross-sectional study was carried out at Menoufia university hospital over a one year period between December 2016 and December 2017. It included 30 children on maintenance hemodialysis (MHD) reduced to 25 patients at the end of the study and 18 control children with matching age and sex.
The study protocol was approved by the local ethics committee of the Menoufia University and written informed consents were obtained from children parents.
Patients aged between 2 and 18 years and on regular HD for 6 months at least using the same HD technique during the last 3 months were included while patients aged more than 18 years, not on regular hemodialysis or suffering a comorbidity like the malignancy were excluded from this study.
Both cases and control were subjected to: a full history taking stressing on the etiology of the renal disease and vascular access, complete physical examination, URR and Sp Kt/V were calculated for all patients and Laboratory investigations were done:
a- Routine investigation(CBC, Urea, creatinine….etc)
b- Non routine (calcium, phosphorus, parathyroid hormone). Our results showed, the mean age of cases was 12.88 years old and that of the control was 10.7yrs old. There was no difference in the gender among cases as males and females were equal, in control 55.6% were male and 44.6% were female.
The mean value of body weight of cases was 27.7 Kg, while it was 35.8Kg among control. The mean height of cases was 126.2 Cm and 136.9 Cm among control, with a height z score below (-2) in 73.3% of cases and 5.6% of control and from -2 to +2 in 26.7% of casesas compared to 94.4% of control. The mean BMI was 17.2 among cases and 18.37 among control..
During the study, the majority of cases (46.7%) have normal blood pressure while 13.3% were prehypertensive, 26.7% had hypertension and only 13.3% had hypotension, While 100% of control had normal B.P. The cause of ESRD in children was unknown in 43.3%, CAUKT in 26.6%, GN in 20% of patients and cystic kidney in 10%. The initial access was AV and temp. Femoral shunt was equal in 3.3% of cases, permenant catheter in 13.3%, and temp. Jugular was used in 80% of included cases. The current access was AVF in 90% of cases. The causes of failure of pervious fistulas were thrombosis in 50% of cases followed hypotension in 20% and trauma in 3.3% but only 26.7% had no failure
The type of used medications was Epirex, I.V iron therapy. About 96.7% of patients used Calcimat and one alpha and L carnitine were used in 93.3% of patients. The antihypertensive drugs were used by 30% of patients.
In our study 23.3% of causes of hospital admission was for shunt operation,16.7% was due to pleural effusion,16.7% was due to hypertensive crises, while 13.3% hadn′t history of hospitalization.30% of patients had hypertension,16.7% suffering cardiomyopathy 6.7% had DM, 6.7% had HCV, while 13.3% of cases didn′t suffer disease rather than renal failure. 33.3% of cases had history of multiple times of blood transfusion, 23.3% of cases had blood transfusion one time while 20% of cases hadn′t history of blood transfusion. Results showed non significant difference among cases and control regarding total protein, albumin and CRP, but there were highly significant difference among cases and control regarding ALP,HB,PTH and HCT which was with in refrence range in 100% of control , below normal in 50% of cases and with in normal in 50% of patients.
All patients were subjected to 3 sessions per week and the duration of dialysis session was 180 min in 16.70% of patients and 240 min in 83.3% of subjects with a mean 2.47 hours for each session. The conventional dialysis was used in 73.3% of cases while only 26.6% used HDF. The rate of blood flow rate was 126.33 ml/min with a range from 40-190 and heparin 1000 u/h was used in 36.6%, 500 u/h heparin was used in 36.6% but heparin 250 and 750 u/h were used in 10% and 16.7% of cases. The bicarb dialysate and hepatitis B vaccination were used in all included patients. The multiple rate of transfusion was 30% of cases, 16.7%, 20%, 10%, 6.7% of patients were subjected to once, twice, 3times, 5 times transfusion respectively. Also, only 16.7% were not subjected to transfusion.