Editing Kidney dialysis (section)

==Pediatric dialysis==
Over the past 20 years, children have benefited from major improvements in both technology and clinical management of dialysis. [[Morbidity]] during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Non-invasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs.<ref>{{cite journal |vauthors=Britto TI, Hoque ME, Fattah SA |date=January 2024 |title=A Systematic Review of Pediatric Dialysis in Asia: Unveiling Demographic Trends, Clinical Representation, and Outcomes |journal=Cureus |volume=16 |issue=1 |pages=e51978 |doi=10.7759/cureus.51978 |pmc=10857885 |pmid=38344624 |doi-access=free}}</ref> [[Case fatality rate|Mortality]] in paediatric and young adult patients on chronic hemodialysis is associated with multifactorial markers of nutrition, [[inflammation]], [[anaemia]] and dialysis dose, which highlights the importance of multimodal intervention strategies besides adequate hemodialysis treatment as determined by Kt/V alone.<ref>{{cite journal |vauthors=Gotta V, Tancev G, Marsenic O, Vogt JE, Pfister M |date=February 2021 |title=Identifying key predictors of mortality in young patients on chronic haemodialysis-a machine learning approach |journal=Nephrology, Dialysis, Transplantation |volume=36 |issue=3 |pages=519–528 |doi=10.1093/ndt/gfaa128 |pmid=32510143}}</ref>

Biocompatible [[synthetic membranes]], specific small size material dialyzers and new low extra-corporeal volume tubing have been developed for young infants. Arterial and venous tubing length is made of minimum length and diameter, a <80&nbsp;ml to <110&nbsp;ml volume tubing is designed for pediatric patients and a >130 to <224&nbsp;ml tubing are for adult patients, regardless of blood pump segment size, which can be of 6.4&nbsp;mm for normal dialysis or 8.0mm for high flux dialysis in all patients. All dialysis machine manufacturers design their machine to do the pediatric dialysis. In pediatric patients, the pump speed should be kept at low side, according to patient blood output capacity, and the clotting with heparin dose should be carefully monitored. The high flux dialysis (see below) is not recommended for pediatric patients.<ref>{{cite journal |vauthors=Britto TI, Hoque ME, Fattah SA |date=January 2024 |title=A Systematic Review of Pediatric Dialysis in Asia: Unveiling Demographic Trends, Clinical Representation, and Outcomes |journal=Cureus |volume=16 |issue=1 |pages=e51978 |doi=10.7759/cureus.51978 |pmc=10857885 |pmid=38344624 |doi-access=free}}</ref>

In children, [[hemodialysis]] must be individualized and viewed as an "integrated therapy" that considers their long-term exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning. Long-term chronic dialysis, however, the highest standards should be applied to these children to preserve their future "cardiovascular life"—which might include more dialysis time and on-line hemodiafiltration online hdf with synthetic high flux membranes with the surface area of 0.2&nbsp;m<sup>2</sup> to 0.8&nbsp;m<sup>2</sup> and blood tubing lines with the low volume yet large blood pump segment of 6.4/8.0&nbsp;mm, if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.<ref>{{cite journal |vauthors=Fischbach M, Edefonti A, Schröder C, Watson A |date=August 2005 |title=Hemodialysis in children: general practical guidelines |journal=Pediatric Nephrology |volume=20 |issue=8 |pages=1054–1066 |doi=10.1007/s00467-005-1876-y |pmc=1766474 |pmid=15947992}}</ref>