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

Abstract

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.

Mortality Risk Among Children Initially Treated With Dialysis for End-Stage Kidney Disease, 1990-2010

“…17,27,28 It is possible the increasing experience of clinicians treating small children, combined with the implementation of new technologies, may also have played a role.…”

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].…”

Vascular Access for Hemodialysis

“…In the United States, less than 800 paediatric patients receive maintenance HD therapy. The majority of smaller patients especially those less than 10kg or less than 2 years old, receive PD [74][75][76]. However, hemodialysis can be performed successfully in infants and very young children, as well [77].…”