Daily Online Hemodiafiltration: Rescue Dialysis Modality for Children?
Bibliographic record
Abstract
There is a growing interest in the use of daily dialysis since long‐term experiences have shown good results. Online hemodiafiltration (OL‐HDF) is an HDF technique that combines diffusion with high convection in which the ultrapure dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (OL‐HDF). Five children with left ventricular hypertrophy, mean age 12.3 ± 6.2 years, on standard 3– 4 h 3 times a week OL‐HDF at least during the last 6 months, were switched to D‐OL‐HDF, 3– 4 h 6 times per week with a minimal follow up of 6 months. Dialysis parameters were similar during both periods and only frequency of each session was changed. Tolerance, anemia control, phosphatemia, and phosphate binders, need of blood pressure medications, and left ventricular hypertrophy were evaluated. Only 3 of the 5 enrolled children could be followed 12 months, 1 was transplanted after 3 months, the other after 5 months D‐OL‐HDF. For all the children the disappearance of postdialysis fatigue was rapidly reported. There was a significant decrease in predialysis levels of phosphatemia (from 1.67±0.23 to 1.28±0.29 mmol/L) despite phosphate binders reduction of more than 50%. Hemoglobin significantly increased (from 11.8±0.9 to 13.4±1.3 g percentage ml) allowing EPO doses reduction. Left ventricular hypertrophy disappeared after 6 months D‐OL‐HDF, fractional shortening increased, allowing registration on transplantation list for 1 child. Our results clearly demonstrate that daily online HDF is able to offer to children on chronic dialysis a marked reduction of the cardiovascular risk factors. Is it ethical to reserve this dialysis modality only to selected children?
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".