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The optimal approach to peritoneal dialysis prescription in children
M Fischbach1, J Terzic, V Bergère
1Nephrology Dialysis Transplantation, Children's Unit, Strasbourg, France.
Insights
Automated peritoneal dialysis (APD) is preferred for children. Optimizing fill volume and dwell time during APD is crucial to prevent complications like lymphatic reabsorption and ensure effective waste removal.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Peritoneal dialysis (PD) is a vital treatment for pediatric kidney disease.
- Automated peritoneal dialysis (APD) is the predominant PD modality in children, differing from adult practices.
Purpose of the Study:
- To outline the best practices for prescribing peritoneal dialysis in pediatric patients.
- To identify key considerations for optimizing APD in children.
Main Methods:
- A comprehensive review of existing medical literature on pediatric peritoneal dialysis.
- Analysis of established protocols and research findings related to PD prescription.
Main Results:
- Automated peritoneal dialysis (APD) is the primary method for pediatric PD.
- Prone positioning during rest may enhance fill volume and efficacy compared to upright positions.
- Nocturnal APD requires careful management of fill volume and dwell time to avoid lymphatic reabsorption and ensure adequate solute clearance.
Conclusions:
- Optimal APD prescription in children necessitates balancing fill volume and dwell time.
- Avoiding excessive fill volumes prevents lymphatic reabsorption and fluid/electrolyte imbalances.
- Sufficient dwell times are essential for effective creatinine and phosphate clearance, even with adequate urea clearance.
Objective:
To describe the optimal approach to peritoneal dialysis (PD) prescription in children.
Design:
Review of the available literature.
Results:
Unlike the situation in adults, the main method used for PD in children is automated peritoneal dialysis (APD). The prone position, while resting, permits the dialysis prescription to use a higher fill volume (IPV), as in continuous ambulatory peritoneal dialysis (CAPD), and is also probably more effective than PD in an upright position. However, because APD is limited to 10 hours, the dialytic effectiveness of nocturnal APD should avoid two potential risks: (1) use of too high an IPV per exchange, inducing lymphatic reabsorption, a factor in unsuitable water and sodium balance [Fischbach M. Peritoneal dialysis prescription for neonates. Perit Dial Int. 1996; 16(Suppl):S52-4]; and (2) use of too short a dwell time per exchange, limiting the purification of creatinine and phosphate despite an apparently adequate urea purification (Malhotra C, Murota GH, Tzamaloukas AH. Creatinine clearance and urea clearance in PD: What to do in case of discrepancy. Perit Dial Int. 1997; 17:532-5).