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Longitudinal evaluation of transport kinetics in children receiving peritoneal dialysis
B A Warady1, B Fivush, S P Andreoli
1The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA, bwarady@cmh.edu
Insights
The peritoneal membrane remains functionally stable in children undergoing long-term peritoneal dialysis (PD). However, peritonitis history may impact solute transport, necessitating monitoring in these patients.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Dialysis Technology
Background:
- Peritoneal dialysis (PD) relies on the functional stability of the peritoneal membrane.
- Long-term PD outcomes in pediatric patients are less understood.
- Peritoneal membrane function is crucial for effective dialysis treatment.
Purpose of the Study:
- To evaluate the longitudinal functional stability of the peritoneal membrane in children on long-term PD.
- To assess the impact of peritonitis history on peritoneal solute transport.
- To identify potential risks for ultrafiltration failure and sclerosing peritonitis.
Main Methods:
- Longitudinal evaluation of 26 pediatric PD patients (mean age 11.0 years).
- Standardized peritoneal equilibration tests conducted twice (mean interval 19.8 months).
- Assessment of solute dialysate to plasma (D/P) ratios, D/D(0) ratios, and mass transfer area coefficients (MTAC).
Main Results:
- No significant overall changes in MTAC, D/P, or D/D(0) values were observed.
- Creatinine and glucose transport were significantly higher in patients with peritonitis history.
- Peritonitis history correlated with significant changes in MTAC creatinine and D/D(0) glucose over time.
Conclusions:
- The pediatric peritoneal membrane demonstrates functional stability during long-term PD.
- Patients with a history of peritonitis may exhibit altered solute transport kinetics.
- Regular monitoring of peritoneal solute kinetics is recommended for pediatric PD patients with peritonitis history.
Abstract:
Functional stability of the peritoneal membrane is necessary for maintenance of peritoneal dialysis (PD) as a therapeutic option. Few studies have investigated this issue in children. We evaluated the peritoneal membrane solute transport capacity longitudinally in 26 children (mean age 11.0+/-5.5 years) receiving long-term PD. Each patient underwent a standardized peritoneal equilibration test on two occasions (mean interval between studies 19.8+/-5.9 months) to determine solute dialysate to plasma (D/P) ratios, dialysate glucose to initial dialysate glucose (D/D(0)) ratios, and mass transfer area coefficients (MTAC). The correlation of transport capacity with peritonitis history was also assessed. No significant change in MTAC, D/P, or D/D(0) values were found when comparing original and follow-up data of the group overall. However, transport of creatinine and glucose was significantly (P<0.05) greater in the peritonitis group compared with the group without peritonitis, and differences in the change over time between the peritonitis groups was significant for MTAC creatinine (P=0.035) and D/D(0) glucose (P=0.020). In summary, this experience demonstrates functional stability of the peritoneal membrane in pediatric patients receiving PD. However, follow-up assessments of peritoneal solute kinetics may be necessary in patients with a history of peritonitis in order to permit early identification of those who may be at risk for ultrafiltration failure and sclerosing peritonitis.