RenalWeb links to a paper that looks at the impact of higher doses of dialysis in kids. Turns out higher doses of dialysis leads to better outcomes.
Intensified hemodialysis regimens: neglected treatment options for children and adolescents by Müller, et al (Pediatric Nephrology), concludes:
Virtually all studies consistently demonstrate that intensified hemodialysis modalities provide improvement in quality of life, biochemical and cardiovascular parameters, and likely anemia and nutrition. Provided that a solution to the reimbursement problem is found, intensified dialysis is expected to become a prevalent choice in the treatment of ESRD.
[snip]
Given the increasing shortage of donor organs, intensified regimes reducing the side effects of ESRD are mandatory. It should be realized that standard hemodialysis provides only minimal requirements of survival with renal replacement therapy. The still limited data from pediatric centers as well as our own experience imply that intensified is an effective and safe method with superior clinical outcomes compared with conventional hemodialysis or peritoneal dialysis.
It's a question of reimbursement but it is also incumbent on nephrologists to end their modality neutrality and tell people what is their best renal replacement option.
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