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Validation of PD Adequest 2.0 for pediatric dialysis patients
B A Warady1, S L Watkins, B A Fivush
1The Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
PD Adequest 2.0 software shows good agreement for predicting solute removal in pediatric peritoneal dialysis (PD) patients. This tool aids in optimizing PD prescription for children, though ultrafiltration prediction requires further study.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Biomedical Engineering
Background:
- Kinetic modeling is established for adult peritoneal dialysis (PD) prescription.
- Clinical application in pediatric PD patients is less studied.
- Accurate PD prescription is crucial for effective treatment in children.
Purpose of the Study:
- To evaluate the PD Adequest 2.0 software as a prescription aid for pediatric PD patients.
- To compare measured and predicted PD clearances, drain volumes, and ultrafiltration.
- To assess the software's accuracy in managing long-term PD in children.
Main Methods:
- 34 pediatric PD patients underwent a 4-hour peritoneal equilibration test.
- Standardized test exchange volume (1,100 ml/m2 BSA) was used.
- Measured and predicted values for solute removal, drain volume, and ultrafiltration were analyzed using correlation coefficients and Bland-Altman limits.
Main Results:
- Good agreement (r=0.75-0.98) was found between measured and predicted values for solute removal and total drain volume.
- Correlation for net ultrafiltration was lower (r=0.34).
- 75% of patients had modeled urea and creatinine clearances within 20% of measured values.
Conclusions:
- PD Adequest 2.0 predicts urea and creatinine clearances with reasonable accuracy in pediatric PD patients.
- The software is a valuable resource for optimizing PD prescription in children.
- Further evaluation of net ultrafiltration prediction in pediatric PD is warranted.
Abstract:
Kinetic modeling has proven to be a valuable tool for peritoneal dialysis (PD) prescription in adult PD patients. The clinical application of this procedure has rarely been studied in children. We therefore evaluated the PD Adequest 2.0 for Windows program (Baxter Healthcare Co., Deerfield, IL) as a prescription aid for the management of pediatric PD patients by comparing the measured and predicted PD clearances, total drain volumes, and net ultrafiltration in 34 children (15 males) (mean age 10.9 +/- 6.0 years) receiving long-term PD. In each case, a 4-h peritoneal equilibration test was conducted with a standardized test exchange volume of 1,100 ml/m2 BSA. A total of 43 24-h dialysate (plus urine in 12) collections were analyzed. The levels of agreement between measured and predicted values for weekly peritoneal and total urea Kt/V, weekly peritoneal and total creatinine clearance, daily drain volume, net ultrafiltration and daily peritoneal urea and creatinine mass removal were assessed with correlation coefficients (re) and Bland-Altman limits of agreement. The study revealed that there is a basic level of agreement between measured and modeled values for solute removal and total drain volume, with correlation coefficients ranging from 0.75 to 0.98. In contrast, the rc for net ultrafiltration was only 0.34. The majority (75%) of patients had modeled urea and creatinine clearances that were within 20% of their measured values. These data suggest that the PD Adequest 2.0 for Windows program can predict urea and creatinine clearances with reasonable accuracy in pediatric PD patients, making it a valuable resource in prescription management.