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Peritoneal transport characteristics with glucose polymer-based dialysis fluid in children

Esther Rusthoven1, Raymond T Krediet, Hans L Willems

  • 1Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands. erusthovern@xs4all.nl <erusthovern@xs4all.nl>

Journal of the American Society of Nephrology : JASN
|October 27, 2004
PubMed

Insights

Pediatric peritoneal dialysis patients showed similar transport parameters with glucose polymer-based dialysate (icodextrin) and glucose, except for lower ultrafiltration with icodextrin. Aquaporin-mediated water transport differs between children and adults, but clinical efficacy remains comparable.

Area of Science:

  • Nephrology
  • Pediatric Nephrology
  • Peritoneal Dialysis

Background:

  • Limited data exist on glucose polymer-based dialysate use in pediatric peritoneal dialysis.
  • Understanding dialysate effects on fluid kinetics and solute transport is crucial for optimizing treatment in children.
  • Comparing pediatric and adult responses to different dialysates can reveal age-related physiological differences.

Purpose of the Study:

  • To investigate the effects of glucose polymer-based dialysate (icodextrin) on peritoneal fluid kinetics and solute transport in pediatric patients.
  • To compare these effects with those of standard glucose dialysate in the same children.
  • To compare pediatric findings with previously published data from adult patients on chronic peritoneal dialysis.

Main Methods:

  • Nine pediatric patients on chronic peritoneal dialysis underwent two peritoneal equilibration tests.
  • Test solutions included 3.86% glucose and 7.5% icodextrin, with Dextran 70 as a volume marker.
  • Serum and dialysate samples were analyzed for urea, creatinine, and sodium; transcapillary ultrafiltration (TCUF) and aquaporin-mediated (AQP) water transport were calculated.

Main Results:

  • In children, transport parameters were similar for icodextrin and 3.86% glucose, except for lower TCUF with icodextrin (0.9 ml/min/m²) versus glucose (4 ml/min/m²).
  • Compared to adults, children showed significantly lower TCUF and marker clearance with icodextrin.
  • AQP-mediated water flow was higher in children than adults for both glucose (83% vs 50%) and icodextrin (18% vs 7%), but absolute AQP flow was identical for 3.86% glucose in both groups.

Conclusions:

  • In pediatric peritoneal dialysis, icodextrin demonstrates similar transport parameters to glucose, with the exception of reduced transcapillary ultrafiltration.
  • Differences in AQP-mediated water transport exist between pediatric and adult patients, suggesting variations in peritoneal membrane characteristics.
  • Despite physiological differences in AQP functionality, the clinical efficacy of peritoneal dialysis appears comparable between pediatric and adult patients using 3.86% glucose.

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