DOQI guidelines recommend minimal standards for automated peritoneal dialysis (APD), with a weekly Kt/V of 2.1 and creatinine clearance (Ccr) of 63 l/1.73 m2. The purpose of this study was to assess if the DOQI guidelines could be met by dialysis alone in children on PD. Dialysis clearance studies were retrospectively analyzed in 20 pediatric patients on APD, all with a dwell volume of at least 1,000 ml/m2. Mean dialytic Kt/V was 2.0; only 45% had a Kt/V above the recommended 2.1. Mean dialytic Ccr was 43.5 l/week per 1.73 m2; only 10% achieved a Ccr above the recommended 63 l/week per 1.73 m2. Despite the significant correlation between total therapy volume (TTV) and both Kt/V and Ccr, only 2 of 10 patients with a TTV over 10 l/m2 per day reached the target Ccr. All patients had currently recommended dwell volumes, therapy times, and nocturnal cycles, but DOQI guidelines were difficult to achieve with dialysis alone. Strict adherence to DOQI guidelines in anephric pediatric PD patients may result in changing dialysis modality. However, without evidence of a correlation between delivered dose of dialysis and improved outcome, adequate dialysis should not be assessed by only measuring Kt/V and Ccr.
Failure of peritoneal dialysis (PD) immediately following soft catheter insertion is well recognized and may be manifest by dialysate leakage, early peritonitis, or early inadequate outflow (1,2), the latter of which requires catheter replacement in up to 50% of cases (1). We describe 3 infants with failure of continuous cyclic peritoneal dialysis CCPD) following PD catheter insertion, as a result of poor dialysate outflow. In each case adequate dialysis was achieved using tidal PD.
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