Devices for long-term hemodialysis in small children—a plea for action

International registry data show that 11% to 37% of children initiating maintenance hemodialysis (HD) weigh less than 20 kg, with 4% to 14% weighing between 10 and 15 kg and 2% to 9% less than 10 kg. 1 Bonthuis M. Vidal E. Bjerre A. et al. Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol. 2021; 36: 2337-2348 Crossref PubMed Scopus (19) Google Scholar , 2 United States Renal Data System2021 USRDS Annual Data Report: epidemiology of kidney disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. https://adr.usrds.org/2021Date: 2021 Date accessed: July 25, 2022 Google Scholar , 3 International Pediatric Dialysis Network. http://www.pedpd.org/Date accessed: September 11, 2022 Google Scholar The smaller blood volume in young children necessitates both low-volume tubing systems and dialyzers, and dialysis machines with a high precision of ultrafiltration control. The safe and tolerable extracorporeal blood volume in an individual is less than 8 ml/kg body weight, corresponding to 10% of the total blood volume. 4 Fischbach M. Edefonti A. Schroder C. et al. Hemodialysis in children: general practical guidelines. Pediatr Nephrol. 2005; 20: 1054-1066 Crossref PubMed Scopus (119) Google Scholar If the extracorporeal volume exceeds this limit, circuit priming with human albumin or with packed red blood cells is recommended, 4 Fischbach M. Edefonti A. Schroder C. et al. Hemodialysis in children: general practical guidelines. Pediatr Nephrol. 2005; 20: 1054-1066 Crossref PubMed Scopus (119) Google Scholar which could expose children to foreign proteins and blood from multiple donors, with an inherent risk of allergic reactions, blood-borne infections, and human leucocyte antigen sensitization.