Can the DOQI guidelines be met by peritoneal dialysis alone in pediatric patients?

Abstract

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.

Clinical practice guidelines for pediatric peritoneal dialysis

“…In pediatrics, there are no randomized clinical trials validating adequacy with outcome. Van der Voort et al retrospectively reviewed their pediatric PD patients and found that only 45% of patients achieved the recommended NKF-DOQI Kt/V targets [62] (level V). Unfortunately, as clinical outcomes were not provided, it is difficult to come to any conclusion with respect to the importance of achieving the suggested Kt/V targets in children.…”

Residual Renal Function in Children Treated with Chronic Peritoneal Dialysis

“…Both in CAPD [ 82 ] and APD [ 83 ] patients, strong linear relations were found between residual GFR and volume of diuresis and twKt/V and twCCr ( r = 0.50–0.92, P < 0.05). van der Voort et al [ 81 ], Kim et al [ 9 ], and Montini et al [ 84 ] found that increasing volume and osmolarity of dialysate fluid allowed maintaining normal twKt/V in anuric children treated with chronic PD (CAPD/APD), but twCCr in these patients was significantly lower ( P < 0.05) compared to children with preserved diuresis. Similarly, in a Finnish study Höltta et al evaluated dialysis adequacy in 21 children treated with APD for 9 months and found that, with decreasing residual diuresis, twKt/V was maintained at a constant normal level but twCCr decreased [ 80 ].…”

Should the Doqi Adequacy Guidelines be used to Standardize Peritoneal Dialysis in Children?

“…And is there reason to support the use of those targets in the pediatric population? (21) In a retrospective, single-center analysis of 20 pediatric patients on APD, all of whom received 10 hours of nightly dialysis and an exchange volume of at least 1000 mL/m 2 BSA and 17 of whom had a daytime dwell, van der Voort and colleagues (22) reported that, by dialysis alone (that is, without the addition of RRF), just 45% of patients achieved a Kt/V urea of at least 2.1 (mean: 2.0), and just 10% achieved a weekly creatinine clearance of at least 63 L/1.73 m 2 (mean: 43.5 L/ 1.73 m 2 ). In contrast, Hölttä et al (23) studied the courses of 21 children, 12 of whom were anephric following bilateral nephrectomy as treatment for congenital nephrotic syndrome of the Finnish type.…”