Peritoneal Dialysis Tailored to Pediatric Needs

Abstract

Consideration of specific pediatric aspects is essential to achieve adequate peritoneal dialysis (PD) treatment in children. These are first of all the rapid growth, in particular during infancy and puberty, which must be accompanied by a positive calcium balance, and the age dependent changes in body composition. The high total body water content and the high ultrafiltration rates required in anuric infants for adequate nutrition predispose to overshooting convective sodium losses and severe hypotension. Tissue fragility and rapid increases in intraabdominal fat mass predispose to hernia and dialysate leaks. Peritoneal equilibration tests should repeatedly been performed to optimize individual dwell time. Intraperitoneal pressure measurements give an objective measure of intraperitoneal filling, which allow for an optimized dwell volume, that is, increased dialysis efficiency without increasing the risk of hernias, leaks, and retrofiltration. We present the concept of adapted PD, that is, the combination of short dwells with low fill volume to promote ultrafiltration and long dwells with a high fill volume to improve purification within one PD session. The use of PD solutions with low glucose degradation product content is recommended in children, but unfortunately still not feasible in many countries.

Mesenchymal Conversion of Mesothelial Cells Is a Key Event in the Pathophysiology of the Peritoneum during Peritoneal Dialysis

“…However, classical glucose-based PD fluids are still needed, because the new-generation biocompatible solutions are expensive and many potential users cannot afford them. One possibility to reduce the adverse effects of classical PD fluids on the peritoneum is by decreasing the dwell time of the dialysate [ 23 , 24 ]. Another alternative approach to preserve the peritoneal membrane could be the use of pharmacological agents protecting the mesothelium or targeting inflammation and fibrosis [ 25 , 26 ].…”

Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

“…Adult peritoneal dialysis patients, who routinely undergo PET, have their peritoneal dialysis prescription based on peritoneal membrane transport status but in contrast, pediatric peritoneal dialysis patients have practical difficulty in performing standardized PET. Hence, most of pediatric peritoneal dialysis patients have their prescription based on an assumption of high transport status [8][9][10][11][12]. Younger children have been described to have high peritoneal membrane transport status as compared to older pediatric populations [8].…”

Peritoneal Dialysis in Children

“…These IPP values correspond to a fill volume of about 1,400-and 800-ml/m 2 BSA (Fig. 1), respectively, which should probably not be exceeded [254]. Prospective studies supporting these suggestions, however, have not yet been performed.…”