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Adequacy of dialysis with tidal and continuous cycling peritoneal dialysis in children
T Hölttä1, K Rönnholm, C Holmberg
1Division of Paediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
Insights
Tidal peritoneal dialysis (TPD) and continuous cycling PD (CCPD) offer adequate dialysis for children. TPD is recommended for pediatric patients with high membrane permeability or outflow issues due to higher costs.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Dialysis Technology
Background:
- Peritoneal dialysis adequacy is a key outcome measure.
- Tidal peritoneal dialysis (TPD) was developed to enhance dialysis efficacy.
- Previous TPD studies yielded inconsistent results, especially in pediatric populations.
Purpose of the Study:
- To compare the efficacy of TPD and CCPD in pediatric patients.
- To evaluate optimal dialysis prescriptions for children undergoing PD.
- To assess TPD's effectiveness across different age groups and membrane characteristics.
Main Methods:
- A comparative study involving 17 pediatric patients (9 under 5 years, 8 over 5 years).
- Patients underwent both TPD and CCPD for 6-month periods.
- Key parameters monitored included urea K(t)/V, creatinine clearance (CrCl), and peritoneal membrane capacity.
Main Results:
- TPD demonstrated a significantly higher dialysate flow rate compared to CCPD.
- Mean total creatinine clearance was higher with TPD, though urea K(t)/V was similar between modalities.
- TPD showed benefits in patients with high peritoneal membrane permeability; no significant differences were observed between age groups.
Conclusions:
- Both TPD and CCPD are effective dialysis modalities for pediatric patients.
- TPD is advisable for children with high membrane permeability, reduced ultrafiltration, or outflow-related complications.
- Cost-effectiveness should be considered when selecting TPD for pediatric patients.
Background:
Today the major outcome measure for peritoneal dialysis is adequacy. We seek the optimal dialysis modality and prescription for each patient. Tidal dialysis (TPD) was introduced in 1990 to increase efficacy. However, studies with TPD have been inconsistent, and results in small children are lacking.
Methods:
Nine patients under and eight patients over 5 years of age who were undergoing or starting maintenance peritoneal dialysis (PD) were studied. Patients were dialysed with TPD and with continuous cycling PD (CCPD), each for 6 months. To optimize TPD and CCPD modalities, we recorded urea K(t)/V, creatinine clearance (CrCl), peritoneal membrane capacity, clinical examination, biochemical values and nutrition.
Results:
The mean nightly dialysate flow rate was significantly higher with TPD than with CCPD (46.4+/-3.7 vs 32.7+/-4.6 ml/kg/h, P:<0.001). Mean total CrCl at the baseline was significantly higher with TPD (79. 3+/-18.5 vs 72.5+/-16.0, P:=0.02), but urea K(t)/V was similar (3. 5+/-0.5 vs 3.3+/-0.4, P:=0.28). Urea K(t)/V and CrCl were higher during TPD in patients with high peritoneal membrane permeability, but similar in patients with high-average membrane permeability. Urea K:(t)/V and CrCl in CCPD and TPD did not differ significantly in the age groups. Nor did the incidence of hypertension differ in CCPD and TPD, despite a significantly lower glucose concentration during TPD.
Conclusions:
Both TPD and CCPD provide adequate dialysis for paediatric patients under and over 5 years of age. Because of higher costs, we recommend TPD only for paediatric patients with high membrane permeability and reduced ultrafiltration or with mechanical outflow problems or outflow pain.