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A multicenter survey on automated peritoneal dialysis prescription in children
E Verrina1, G Zacchello, A Edefonti
1Nephrology Division, G. Gaslini Children's Hospital, Largo G. Gaslini, 5, Genoa 16148, Italy.
Insights
Automated peritoneal dialysis (APD) offers flexible treatment for pediatric patients. This study analyzes APD regimens, finding average nightly sessions of 10 hours and fill volumes tailored to individual needs.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Renal Replacement Therapy
Background:
- Automated peritoneal dialysis (APD) is the preferred chronic dialysis method for children.
- Nocturnal APD minimizes disruption to daily life for patients and families.
- Prescription flexibility allows tailoring APD to diverse pediatric needs.
Purpose of the Study:
- To analyze the dialytic regimens and prescription parameters used in pediatric APD.
- To compare nightly intermittent peritoneal dialysis (NIPD), tidal peritoneal dialysis (TPD), and continuous cycling peritoneal dialysis (CCPD) in children.
Main Methods:
- Data collected from 12 pediatric dialysis centers on 110 children undergoing APD.
- Recorded prescription parameters including exchanges, duration, dwell volume (mL/kg BW), and glucose concentration.
- Analyzed regimens: NIPD (n=64), TPD (n=29), and CCPC (n=17).
Main Results:
- Average nightly APD session duration was 10 hours across all regimens.
- Average fill volume was 36 mL/kg body weight.
- Daytime dwell volume averaged approximately 50% of nighttime fill volume.
Conclusions:
- Pediatric APD prescriptions show wide variability due to patient age, size, and metabolic requirements.
- Despite variations, key parameters like session duration and fill volume are consistent.
- APD allows for personalized treatment schedules in pediatric patients requiring chronic dialysis.
Abstract:
Automated peritoneal dialysis (APD) is considered the first-choice chronic peritoneal dialysis modality for pediatric patients. Nighttime APD courses reduce the impact of PD treatment on a patient's and family's way of life, and the wide range of prescription options permit the dialysis schedule to be tailored to the needs of children of varying age and body size. We registered data concerning the dialytic regimens adopted in 12 pediatric dialysis centers for the treatment of 110 children on APD. Of the 110 children, 64 (aged 7.6 +/- 5.1 years) were on nightly intermittent peritoneal dialysis (NIPD); 29 (aged 9.2 +/- 4.3 years) were on tidal peritoneal dialysis (TPD); and 17 (aged 8.2 +/- 4.9 years) were on continuous cycling peritoneal dialysis (CCPD). The main prescription parameters for the various regimens (mean +/- standard deviation) were these: NIPD--exchanges: 13.0 +/- 5.8; duration: 10.0 +/- 1.1 hours; dwell volume: 36.5 +/- 6.2 mL/kg body weight (BW); glucose concentration: 1.69% +/- 0.41%. TPD--exchanges: 23.3 +/- 8.1; duration: 10.0 +/- 1.0 hours; dwell volume: 36.1 +/- 5.9 mL/kg BW; glucose concentration: 1.63% +/- 0.37%. CCPD--exchanges: 13.0 +/- 4.7; duration: 10.1 +/- 1.3 hours; dwell volume: 37.7 +/- 5.2 mL/kg BW; glucose concentration: 1.65% +/- 0.28%. Tidal volume was 52.2% +/- 9.0% of initial fill volume. Daytime dwell volume was 54.8% +/- 17.3% of night volume in CCPD patients, and 56.6% +/- 13.3% in 9 patients on continuous TPD. Because the patient population in this report varied in age, body size, and metabolic needs, the resulting range in prescription parameters was quite wide. Nevertheless, the duration of nightly PD sessions averaged 10 hours, fill volume averaged 36 mL per kilogram body weight, and daytime volume averaged 50% of nighttime fill volume.