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Standard peritoneal permeability analysis in children
Antonia H M Bouts1, Jean-Claude Davin1, Jaap W Groothoff1
1Emma Children's Hospital Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Insights
Peritoneal dialysis (PD) transport in children shows no significant differences compared to adults when corrected for body surface area. The study found no correlation with age or PD duration, except for an increased restriction coefficient for macromolecules over time.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Peritoneal Dialysis
Background:
- Peritoneal transport characteristics in children undergoing peritoneal dialysis (PD) are often reported as different from adults.
- Discrepancies may arise from variations in testing methodologies.
Purpose of the Study:
- To investigate and compare peritoneal transport characteristics in pediatric patients undergoing PD with adult data.
- To assess the influence of age and duration of PD treatment on peritoneal membrane function in children.
Main Methods:
- Performed 31 standard peritoneal permeability analyses (SPA) in 18 pediatric PD patients.
- Analyzed solute (creatinine, urea, beta(2)-microglobulin, albumin, IgG, alpha(2)-macroglobulin) and fluid transport parameters.
- Correlated transport parameters with patient age and duration of PD treatment.
Main Results:
- No significant differences in peritoneal fluid and solute transport were found between children and adults when corrected for body surface area.
- No correlation between transport parameters and age or PD duration was observed.
- An increase in the restriction coefficient for macromolecules was noted with longer PD treatment duration (r = 0.38, P = 0.03).
Conclusions:
- The peritoneal membrane in children does not exhibit fundamentally different transport characteristics compared to adults.
- The observed increase in macromolecular restriction with PD duration in children mirrors findings in adult populations.
- This study challenges the notion of distinct peritoneal membrane behavior in pediatric PD patients.
Abstract:
Peritoneal transport characteristics in children on peritoneal dialysis (PD) has been reported to be different compared to adults. However, various test methods can influence this difference. Thirty-one standard peritoneal permeability analyses (SPA) were performed in 18 PD children with a median (range) age of 9.8 yr (2 to 19) and a median duration of PD of 2.6 yr (0.19 to 6.8). The median mass transfer area coefficient (MTAC) for creatinine was 9.6 ml/min per 1.73 m(2) (4.4 to 18.0), and for urea 17.3 ml/min per 1. 73 m(2) (12.2 to 22.8). The median dialysate to plasma creatinine ratio (D/P(Cr)) was 0.69 (0.44 to 0.92), the glucose absorption 59% (23 to 75), and the D/D(0) for glucose 0.38 (0.23 to 0.62). The median clearance of beta(2)-microglobulin was 923 microl/min per 1. 73 m(2) (366 to 1828), of albumin 103 microl/min per 1.73 m(2) (55 to 211), of IgG 48 microl/min per 1.73 m(2) (20 to 105), and of alpha(2)-macroglobulin 12 microl/min per 1.73 m(2) (5 to 49). No correlation was found between these results and age or PD time. The restriction coefficient for macromolecules indeed increased with duration of PD treatment (r = 0.38, P = 0.03). The median transcapillary ultrafiltration rate was 1.2 ml/min per 1.73 m(2) (-0. 01 to 2.8), the net ultrafiltration rate 0.2 ml/min per 1.73 m(2) (-1.97 to 1.82), and the effective lymphatic absorption rate 1.04 ml/min per 1.73 m(2) (-0.06 to 2.91). When corrected for body surface area, no differences were found in peritoneal fluid and solute transport characteristics between children and adults. No effect of time on PD on the transport parameters was found in a cross-sectional analysis, except for an increase of the restriction coefficient to macromolecules. This finding is similar to observations in adults. Therefore, the present study showed no evidence for the common belief that the peritoneal membrane in children is different from that in adult patients.