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Clinical outcome of pediatric patients on peritoneal dialysis under adequacy control
T Hölttä1, K Rönnholm, H Jalanko
1Department of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Finland. Tuula.Holtta@huch.fi
Insights
Adequacy control in pediatric peritoneal dialysis (PD) showed similar outcomes across age groups. Children under 5 experienced improved clinical outcomes with PD adequacy control, suggesting its positive impact.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Continuous peritoneal dialysis (PD) is a treatment for pediatric kidney failure.
- Optimizing PD adequacy is crucial for patient outcomes.
- Age-related differences in PD efficacy and outcomes require investigation.
Purpose of the Study:
- To evaluate clinical outcomes in pediatric patients on continuous PD under adequacy control.
- To compare outcomes between children under 5 and over 5 years of age.
- To assess the impact of PD adequacy control on clinical outcomes in younger children.
Main Methods:
- Study included 21 pediatric patients on continuous PD, divided into two age groups (<5 and >5 years).
- Peritoneal equilibration tests and 24-hour dialysate collections were performed.
- Laboratory data, clinical status, and diet were monitored, with PD prescriptions adjusted accordingly.
Main Results:
- Mean weekly urea Kt/V was similar and stable between age groups.
- Mean weekly creatinine clearance (C(Cr)) was initially lower in younger children but normalized over time.
- Hematological and biochemical parameters remained stable, with 62% of patients showing catch-up growth.
- No significant difference in overall outcome was observed between the age groups.
Conclusions:
- PD adequacy control leads to stable solute clearance and improved clinical outcomes in pediatric patients.
- The positive impact of PD adequacy control was particularly noted in children under 5 years of age.
- Age-appropriate PD management and adequacy control are essential for favorable clinical outcomes in pediatric patients.
Abstract:
Clinical outcome under adequacy control was studied in 10 pediatric patients under 5 years and 11 patients over 5 years of age on continuous peritoneal dialysis (PD). Outcome was compared between the age groups and with our previous results in patients under 5 years of age. Peritoneal equilibration test and 24-h dialysate collection were performed. Laboratory data, clinical status, and diet were recorded. PD prescription was adjusted for these parameters. The mean weekly urea Kt/V was similar and stable in the two age groups (3.1+/-0.6 vs. 3.2+/-0.4 at baseline). The mean weekly creatinine clearance (C(Cr)) was at baseline significantly lower in the younger age group (58.7+/-11.9 vs. 78.0+/-14.9 l/week per 1.73 m2, P=0.004), but later similar. Urea Kt/V and C(Cr) correlated significantly. Hematological and biochemical parameters were stable, and catch-up growth was observed in 62% of the patients during 9 months of follow-up. The outcome for children under and over 5 years of age did not differ significantly. The clinical outcome in patients under 5 years of age improved under adequacy control, when compared with our previous results in patients of the same age. This suggests a positive effect of adequacy control on clinical outcome.