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Suitable dialytic indicators for pediatric peritoneal dialysis patients: the alternative to creatinine clearance
Kenji Ishikura1, Hiroshi Hataya, Masahiro Ikeda
1Department of Pediatric Nephrology, Tokyo Metropolitan Children's Hospital, Tokyo, Japan. ishikura@chp-kiyose-tokyo.jp
Insights
Kt/V urea and Kt/V creatinine (Kt/V creat) are effective measures for pediatric peritoneal dialysis (PD) patients. Creatinine clearance (CCr) is less reliable for children under 6, making Kt/V creat a preferred indicator.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Biomarkers
Background:
- Creatinine clearance (CCr) may underestimate dialysis efficiency in pediatric peritoneal dialysis (PD) patients due to body size discrepancies.
- Kt/V creatinine (Kt/V creat), normalized to total body water (TBW), offers a potentially more accurate assessment.
Purpose of the Study:
- To evaluate dialysis efficiency and nutritional status in pediatric PD patients.
- To compare the utility of CCr and Kt/V creat as dialysis indicators in this population.
Main Methods:
- Analysis of 49 pediatric PD patients (under 20 years).
- Measurement of weekly Kt/V urea, CCr, Kt/V creat, and normalized protein equivalent of nitrogen appearance (nPNA).
- Comparison against Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and a set target for Kt/V creat.
Main Results:
- Pediatric PD patients achieved target Kt/V urea (67.4%) and Kt/V creat (65.3%).
- Patients under 6 years old showed high Kt/V urea (90%) and Kt/V creat (90%) achievement.
- CCr achievement was low overall (26.5%) and particularly for those under 6 (10%).
- Age significantly affected the relationship between CCr and Kt/V urea.
Conclusions:
- Pediatric PD patients met recommended Kt/V urea targets, with nPNA reflecting nutritional status.
- CCr is not a suitable dialysis indicator for pediatric PD patients under 6 years old.
- Kt/V creat is recommended as a more appropriate dialysis indicator for younger pediatric PD patients.
Objective:
Owing to the discord between body weight and body surface area (BSA), creatinine clearance (CCr) is predisposed to be small in pediatric patients on peritoneal dialysis (PD). Alternatively, Kt/V creatinine (Kt/V creat), which is normalized to total body water (TBW) rather than BSA, could be a better dialytic indicator. In this study, the efficiency of dialysis and the nutritional status of pediatric patients on chronic PD were examined, and the utility of dialytic indicators was evaluated.
Patients And Methods:
49 patients under 20 years old, in stable condition, and on PD were analyzed. Weekly total Kt/V of urea (Kt/V urea), CCr, Kt/V creat, and normalized protein equivalent of nitrogen appearance (nPNA) were measured for all patients and for patients under 6 years old. The target value was 2.0/week for Kt/V urea and 60 L/ week/1.73 m2 for CCr, as recommended by the Kidney Disease Outcomes Quality Initiative guidelines. The target value for Kt/V creat was set as 1.52/week, using a male model with a height of 170 cm and a body weight of 65 kg.
Results:
The mean values of delivered Kt/V urea, CCr, Kt/V creat, and nPNA (and proportion of patients that achieved each target value) for all patients were 2.25 +/- 0.57/ week (67.4%), 53.8 +/- 19.3 L/week1/.73 m2 (26.5%), 1.83 +/- 0.73/ week (65.3%), and 1.11 +/- 0.42 g/day, respectively. The values for patients under 6 years old were 2.38 +/- 0.26/week (90.0%), 45.9 +/- 12.8 L/week/1.73 m2 (10.0%), 1.94 +/- 0.51/week (90.0%), and 1.52 +/- 0.67 g/day, respectively. Stepwise multiple regression analyses revealed that the relationship between CCr and Kt/V urea was affected by the patient's age.
Conclusions:
Our pediatric patients achieved the recommended target value of Kt/V urea. At the same time, the nPNA results reflected the patient's status well. However, CCr appeared to be inappropriate as an indicator for patients under 6 years old. Kt/V creat is suggested to be a better dialytic indicator for these patients.