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Intraperitoneal pressure in children: fill-volume related and impacted by body mass index
Michel Fischbach1, Joëlle Terzic, Emmanuel Provot
1Nephrology Dialysis Transplantation Children's Unit, University Hospital, Strasbourg, France. Michel.Fischbach@chru-strasbourg.fr
Insights
Body Mass Index (BMI) significantly influences intraperitoneal pressure (IPP) in children undergoing peritoneal dialysis (PD), impacting individualized treatment. Higher BMI correlates with increased IPP for a fixed intraperitoneal volume (IPV).
Area of Science:
- Pediatric Nephrology
- Peritoneal Dialysis
- Biomedical Engineering
Background:
- Individualizing intraperitoneal volume (IPV) is crucial for optimizing peritoneal dialysis (PD) efficiency and tolerance in children.
- Intraperitoneal pressure (IPP) serves as an objective measure for assessing IPV, but significant inter-individual variability exists.
- Factors beyond IPV likely contribute to the observed variations in IPP.
Purpose of the Study:
- To investigate the relationship between intraperitoneal pressure (IPP) and intraperitoneal volume (IPV) in pediatric patients on PD.
- To identify factors contributing to the inter-individual variability in IPP for a given IPV.
- To explore the influence of Body Mass Index (BMI) and age on IPP in children undergoing PD.
Main Methods:
- A prospective study was conducted over two years with 17 pediatric PD patients.
- Data collected included IPV (ml/m² BSA), age, gender, BMI, and IPP (cm H₂O) at three-month intervals.
- A total of 53 data points were analyzed to assess correlations.
Main Results:
- A weak positive correlation was found between IPV and IPP (r = 0.36).
- A strong positive correlation was observed between BMI and IPP (r = 0.82).
- Age demonstrated a differential effect on IPP: decreasing with age in children < 2 years and increasing with age in children > 2 years. Paradoxical findings of low IPV with high IPP were noted in some infants.
Conclusions:
- BMI is a significant determinant of IPP in pediatric PD patients, explaining much of the inter-individual variability in the IPP-IPV relationship.
- Higher BMI in children undergoing PD is associated with higher IPP for a standardized IPV.
- These findings underscore the importance of considering BMI in the individualized prescription of IPV for pediatric PD.
Objective:
Prescription of intraperitoneal volume (IPV) in children on peritoneal dialysis (PD) should be individualized in order to optimize both efficiency and tolerance. Intraperitoneal pressure (IPP) can be used as an objective assessment of IPV. Despite IPP being correlated with IPV, there is an important interindividual variability presumed to be secondary to other implicated factors.
Design:
Over the past 2 years, we conducted a prospective study in our patients on PD (N = 17). For each child, we recorded, at every third month of follow-up, IPV (in milliliters per square meter body surface area), age, gender, body mass index (BMI), and IPP (measured as centimeters of water), collecting a total of 53 data points.
Results:
There was a positive correlation between IPV and IPP (r = 0.36), but this correlation was weak in contrast to the strong correlation noted between BMI and IPP (r = 0.82). Age had a different influence on IPP: in the younger-aged group (< 2 years), IPP decreased with age; in the older-aged group (> 2 years), IPP increased with age. In some infants, we noted a paradoxical result: a low IPV with a high IPP.
Conclusions:
The strong correlation noted between IPP and BMI gives a better understanding of the interindividual variability of the previously described unique relationship between IPP and IPV. The more obese the child (i.e., the higher the BMI), the higher is his IPP for a fixed IPV.