SickKids first hospital in North America to use new dialysis treatment for paediatric care

Recognizing advances in patient care on World Kidney Day

TORONTO – Imagine being a teenager on dialysis and having to go to the hospital for treatment four days a week for multiple hours at a time. This is the reality for many children and teens with acute or chronic kidney failure whose treatment schedule often stands in the way of school, sports and other regular childhood activities. Now imagine returning home feeling exhausted, too tired to attend school. While dialysis treatment can save a person’s life, it can also come with negative side-effects that may interrupt one’s daily routine and quality of life.

The basic function of kidneys is to balance the volume of water in the body and remove waste products from the blood. When kidneys stop working waste builds up in the body which can affect the brain, lungs, heart, muscles and many other organs. Kidneys also control blood pressure, help make red blood cells and regulate the body’s calcium levels. A common treatment for adults and children with kidney failure is dialysis which is delivered by a machine that plays the role of the kidney by filtering harmful waste and toxins from the blood.  

The Dialysis and Apheresis team at The Hospital for Sick Children (SickKids) have spent the last five years working to implement a new dialysis system called haemodiafiltration to tackle the poor patient outcomes associated with previous forms of dialysis treatments. Implemented in September 2015, this marks the first use of haemodiafiltration for paediatric care in North America.

Most children with kidney failure are on haemodialysis which has been in use at SickKids for the past 30 to 40 years and while it helps to filter the blood it cannot completely clear all the toxins leading to adverse developmental side-effects, including impaired cognitive development and growth, anaemia and a reliance on medication.

“The more toxins we can clear from the blood, the better outcomes we will have for our patients,” explains Dr. Christoph Licht, Medical Director of Nephrology at SickKids.

Haemodiafiltration works by infusing ultra-pure water directly into the patient’s blood stream. This enhances the clearing process of the patient’s blood and removes more toxins from the blood stream than other forms of dialysis helping to reduce the inflammatory response that usually leads to the negative side-effects seen in patients with renal failure on dialysis. Patients on haemodiafiltration may have improved blood pressure, better anaemia control, improved cardiac protection, a larger appetite and the potential for increased physical growth.

“We have found that patients have more energy, live with fewer diet and fluid restrictions and have closer to normal development,” says Licht, who put the wheels in motion to implement the new method, inspired by the successful outcomes of paediatric patients who have used haemodiafiltration overseas. “This is not a cure for kidney failure and does not replace the possible eventual need for kidney transplant, but as doctors, our job is to make dialysis as good as it can be and this new form of dialysis is currently the best option for our patients.”

Sixteen year old Ugbad Ali was diagnosed with end stage kidney disease in April 2015. “I wasn’t feeling well. I had headaches and was throwing up. When I went to the hospital, they found that my bloodwork was out of whack.” She was at SickKids for three weeks before learning that she’d have to continue coming to the hospital multiple times a week for dialysis in order to maintain her health.

Ugbad comes to SickKids for dialysis every week on Mondays, Wednesdays, Fridays and Saturdays. “When I was first diagnosed I started hemodialysis treatment. While I know it was helping me to maintain my health, I had overall fatigue, I didn’t sleep very well and had little energy. I’m at SickKids for 15 hours a week for treatment. I used to spend a lot of that time sleeping; now since starting haemodiafiltration all of a sudden I am more alert and have noticeably more energy. I can do homework, talk with the nurses on the unit, watch TV, or read. I can be more productive with my time and feel better on the days that I don’t have treatment too.”

One to three per cent of children, and 10 per cent of adults worldwide live with kidney disease. Every week about 20 kids and teens come to SickKids for dialysis; those who weigh more than 10 kg are now receiving haemodiafiltration which is the new standard dialysis treatment at SickKids.

“It is so rewarding to see how Ugbad and all our patients are now benefitting from this new method of dialysis. Our team is now doing research to compare patient outcomes after transitioning from haemodialysis to haemodiafiltration to demonstrate the treatment benefits and ensure that we are delivering positive outcomes,” says Licht who is also Associate Professor in the Department of Paediatrics at the University of Toronto.

The new method is in line with a SickKids history of pioneering new dialysis treatments. Dr. Denis Geary, former Chief of Nephrology at SickKids, established nocturnal home haemodialysis and SickKids was also among the first wave of hospitals worldwide to implement peritoneal dialysis for children.

“We’re proud to be keeping with this tradition. To offer the best for our patients, we have to go with the cutting-edge treatment options and right now that is haemodiafiltration,” says Licht. “We’re happy to see patients benefitting from it, but we’re still not at a point where we can rest. We’re going to continue pushing for even better treatments for children with renal failure in the future.”

This work is an example of how SickKids is contributing to making Ontario Healthier, Wealthier and Smarter.