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Impact of fill volume changes on peritoneal dialysis tolerance and effectiveness in children
M Fischbach1, J Terzic, S Menouer
1Nephrology Dialysis Transplantation Children's Unit, CHU Hautepierre, Strasbourg, France.
Insights
Optimizing peritoneal dialysis (PD) fill volume in children requires expressing it per body surface area (BSA) to accurately assess peritoneal function. Individualized approaches suggest optimal volumes are typically below 1400 mL/m2 for better outcomes.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Prescribed fill volume (IPV) in pediatric peritoneal dialysis (PD) is crucial for treatment efficacy.
- Standardized IPV can lead to misinterpretation of peritoneal equilibration test (PET) results, specifically the dialysate-to-plasma (D/P) ratio, suggesting false hyperpermeability.
- Determining the optimal IPV remains a challenge, balancing patient tolerance and treatment effectiveness.
Purpose of the Study:
- To investigate the optimal prescribed fill volume (IPV) in children undergoing peritoneal dialysis (PD).
- To establish a method for individualizing IPV based on physiological parameters.
- To refine the assessment of peritoneal function in pediatric PD patients.
Main Methods:
- Expressing IPV per body surface area (BSA) instead of absolute volume.
- Incorporating measurements of intraperitoneal pressure.
- Utilizing the mass transfer coefficient alongside the D/P ratio from PET.
- Assessing the effective peritoneal area for solute exchange.
Main Results:
- Expressing IPV per BSA is essential to avoid misinterpreting peritoneal equilibration test (PET) findings.
- An individualized approach to IPV prescription is proposed.
- The optimal individual fill volume was frequently found to be less than 1400 mL/m2.
Conclusions:
- Individualized prescribed fill volume (IPV) optimization in pediatric peritoneal dialysis (PD) is critical.
- Using body surface area (BSA) for IPV prescription improves the accuracy of peritoneal function assessment.
- Optimal IPV, determined through a personalized approach, is often below 1400 mL/m2, enhancing both tolerance and effectiveness.
Abstract:
In the last decade, it has became apparent that the prescribed fill volume (IPV) in children on peritoneal dialysis (PD) should be expressed per body surface area (BSA in square meters) to avoid a false perception of peritoneal hyperpermeability as determined during a peritoneal equilibration test [PET, dialysate-to-plasma (D/P) ratio]. Nevertheless, the optimal IPV in terms of both tolerance and effectiveness remains under discussion. An individual approach to IPV prescription might balance the measurement of the intraperitoneal pressure, the use of the mass transfer coefficient despite the D/P ratio, and a determination of the effective peritoneal area available for exchanges. Considering these parameters, we usually found the individual optimal fill volume to be less than 1400 mL/m2.