Dialysis delivery in children on nightly intermittent and tidal peritoneal dialysis

Edefonti, Alberto; Consalvo, G.; Picca, Marina; Giani, Marisa; Damiani, Bruno M.; Ghio, Luciana; Galato, R

doi:10.1007/bf02254202

Cited by 25 publications

(13 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…HDF with a highly permeable membrane is as efficient as HD for low-molecular-weight compounds, but is more efficient than HF for low-molecular-weight compounds [29]. Moreover, HDF, besides its blood purification efficiency, is associated with a lower intradialytic morbidity rate [30, 31], as is HF [3]. On-line HDF [24, 25], in which filtered dialysate free of toxins and pyrogens is used as replacement fluid, enables use of an elevated convection fluid rate, especially in predilution mode, and facilitates a dialysis dose increase without a cost increase.…”

Section: Guideline 5: Principles Of Blood Purificationmentioning

confidence: 99%

Hemodialysis in children: general practical guidelines

Fischbach¹,

et al. 2005

View full text Add to dashboard Cite

Over the past 20 years children have benefited from major improvements in both technology and clinical management of dialysis. Morbidity during dialysis sessions has decreased with seizures being exceptional and hypotensive episodes rare. Pain and discomfort have been reduced with the use of chronic internal jugular venous catheters and anesthetic creams for fistula puncture. Noninvasive technologies to assess patient target dry weight and access flow can significantly reduce patient morbidity and health care costs. The development of urea kinetic modeling enables calculation of the dialysis dose delivery, Kt/V, and an indirect assessment of the intake. Nutritional assessment and support are of major importance for the growing child. Even if the validity of these "urea only" data is questioned, their analysis provides information useful for follow-up. Newer machines provide more precise control of ultrafiltration by volumetric assessment and continuous blood volume monitoring during dialysis sessions. Buffered bicarbonate solutions are now standard and more biocompatible synthetic membranes and specific small size material dialyzers and tubing have been developed for young infants. More recently, the concept of "ultrapure" dialysate, i.e. free from microbiological contamination and endotoxins, has developed. This will enable the use of hemodiafiltration, especially with the on-line option, which has many theoretical advantages and should be considered in the case of maximum/optimum dialysis need. Although the optimum dialysis dose requirement for children remains uncertain, reports of longer duration and/or daily dialysis show they are more effective for phosphate control than conventional hemodialysis and should be considered at least for some high-risk patients with cardiovascular impairment. In children hemodialysis has to be individualized and viewed as an "integrated therapy" considering their longterm exposure to chronic renal failure treatment. Dialysis is seen only as a temporary measure for children compared with renal transplantation because this enables the best chance of rehabilitation in terms of educational and psychosocial functioning. In long term chronic dialysis, however, the highest standards should be applied to these children to preserve their future "cardiovascular life" which might include more dialysis time and on-line hemodiafiltration with synthetic high flux membranes if we are able to improve on the rather restricted concept of small-solute urea dialysis clearance.

show abstract

Section: Guideline 5: Principles Of Blood Purificationmentioning

confidence: 99%

Hemodialysis in children: general practical guidelines

Fischbach¹,

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Patients with a high transporter status can reach adequate solute clearances with nightly TPD, while patients with high-average transport should still additionally benefit from one or more daytime dwells. Studies in pediatric patients showed that TPD was equally or more effective than standard APD but required larger total dialysate volumes, with consequently higher costs [84,131]. Optimization of TPD efficiency can be attained by adapting tidal volume to the drainage profile of each patient, thus reducing the fill and drain dead times [6].…”

Section: Tidal Pdmentioning

confidence: 99%

Peritoneal Dialysis in Children

Patel

Kv³

et al. 2015

Pediatric Nephrology

View full text Add to dashboard Cite

In children with chronic kidney disease stage 5D peritoneal dialysis (PD) remains the dialysis modality most commonly prescribed, especially as automated PD. Nowadays it can be started from the first days of life on, and applied even to some preterm babies. This chapter gives an overview on PD membrane ultrastructure and function, on technical prerequistes of PD, on optimal PD prescription and on specific treatment targets and tools to monitor efficacy. It describes PD related infectious and noninfectious complications, long term peritoneal and systemic sequelae and current state of the art of how these can be mitigated or even be prevented.

show abstract

“…The efficiency of tidal peritoneal dialysis (TPD) is mainly conditioned by total volume of PD fluid delivered and by the individual’s peritoneal transport rate. Patients with high transport rates can reach adequate solute clearances with intermittent nightly TPD, while patients with high average transport rates would benefit from one or more daytime dwells [56, 57]. A further increase of TPD efficiency can be attained by adapting tidal volume to the drainage profile of each patient, thus reducing the fill and drain dead times [58].…”

Section: Prescription For Pd Regimenmentioning

confidence: 99%

Selection of modalities, prescription, and technical issues in children on peritoneal dialysis

2009

View full text Add to dashboard Cite

Peritoneal dialysis (PD) is widely employed as a dialytic therapy for uraemic children, especially in its automated form (APD), that is associated with less burden of care on patient and family than continuous ambulatory PD. Since APD offers a wide range of treatment options, based on intermittent and continuous regimens, prescription can be individualized according to patient's age, body size, residual renal function, nutritional intake, and growthrelated metabolic needs. Transport capacity of the peritoneal membrane of each individual patient should be assessed, and regularly monitored, by means of standardized peritoneal function tests validated in pediatric patients. To ensure maximum recruitment of peritoneal exchange area, fill volume should be scaled to body surface area and adapted to each patient, according to clinical tolerance and intraperitoneal pressure. PD solutions should be employed according to their biocompatibility and potential ultrafiltration capacity; new pH-neutral, glucose-free solutions can be used in an integrated way in separate dwells, or by appropriately mixing during the same dialytic session. Kinetic modelling software programs may help in the tailoring of PD prescription to individual patients' characteristics and needs. Owing to advances in the technology of new APD machines, greater programming flexibility, memorized delivery control, and tele-dialysis are currently possible.

show abstract

Dialysis delivery in children on nightly intermittent and tidal peritoneal dialysis

Cited by 25 publications

References 7 publications

Hemodialysis in children: general practical guidelines

Hemodialysis in children: general practical guidelines

Peritoneal Dialysis in Children

Selection of modalities, prescription, and technical issues in children on peritoneal dialysis

Contact Info

Product

Resources

About