A 5-month-old boy who received acetate-free dialysis

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  • Kamei Koichi
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Tsutsumi Akiko
    Department of Nephrology and Rheumatology, National Center for Child Health and Development Department of Pediatrics, Yokohama Rosai Hospital
  • Noda Shunsuke
    Department of Nephrology and Rheumatology, National Center for Child Health and Development Department of Pediatrics, Shinshu University Hospital
  • Ishikawa Tomoaki
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Sato Mai
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Fujimaru Takuya
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Udagawa Tomohiro
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Ogura Masao
    Department of Nephrology and Rheumatology, National Center for Child Health and Development
  • Ohashi Makito
    Department of Clinical Engineering, National Center for Child Health and Development
  • Isobe Eisuke
    Department of Clinical Engineering, National Center for Child Health and Development
  • Doi Fusae
    Department of Clinical Engineering, National Center for Child Health and Development
  • Kawata Yoko
    Department of Clinical Engineering, National Center for Child Health and Development
  • Minamoto Noriyasu
    Department of Clinical Engineering, National Center for Child Health and Development
  • Ito Shuichi
    Department of Nephrology and Rheumatology, National Center for Child Health and Development

Bibliographic Information

Other Title
  • 無酢酸透析液が有用であった生後５か月の男児例
  • 症例報告 無酢酸透析液が有用であった生後5か月の男児例
  • ショウレイ ホウコク ムサクサン トウセキエキ ガ ユウヨウ デ アッタ セイゴ 5カゲツ ノ ダンジレイ

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Abstract

Infants are prone to hypotension and can easily develop hypovolemic shock during hemodialysis. When they become restless during hemodialysis, bed rest cannot be prolonged and both crying and body movement will cause problems with blood access. Usually, it is difficult to evaluate vital signs and sometimes it is difficult for infants to continue hemodialysis. We performed acetate-free dialysis for a 5-month-old boy who always became discontented during hemodialysis. He demonstrated sudden necrotizing ileus due to intestinal membrane hernia, and developed intestinal perforation, cardiopulmonary arrest and renal failure at the age of 1 month. After recovery from cardiopulmonary arrest, he received surgical resection of 70% of the intestine and was started on parenteral hyperalimentation for short bowel syndrome and hemodialysis using a double-lumen catheter for blood access. Since he could not continue peritoneal dialysis due to intraperitoneal adhesion formation, hemodialysis was performed using a subcutaneously indwelling intravenous catheter via the right external jugular vein. Because he demonstrated chronic discontent and restlessness, we performed acetate-free dialysis, which has been reported to prevent hypotension or disequilibrium during dialysis. After changing to acetate-free dialysis, the infant became calmer and he cried less. There were no adverse events related to acetate-free dialysis. Previous reports have shown that acetate has a vasodilatory effect due to the production of nitric oxide from endothelial cells and it also stimulates the production of inflammatory cytokines by mononuclear cells. We consider acetate-free dialysis effective in preventing hypotension and chronic distress in infants during hemodialysis.

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