Ultrafiltration using low volume peritoneal dialysis in critically ill infants and children

Ultrafiltration (UF) using dialysate volumes of less than 20 ml/kg was assessed in 12 critically ill infants and children with hypervolemia as the primary indication for dialysis. Ten of the 12 required mechanical ventilation (O2 requirements 45-100%). Seven, all infants, received at least one pressor intravenously in attempts to maintain systolic blood pressure of 60. Age was 22 +/- 11.5 mos. (mean +/- SE) with weight of 11.1 +/- 4.3 kg (range 2.4-50 kg). Dialysis prescription was as follows: Volume of 10.1 +/- 1.3 ml/kg/exchange; dwell time 30-45 minutes; drain time 15-20 minutes. Glucose concentration ranged from 1.5-4.25%. Drained dialysate volume expressed as a percent of volume instilled was 133.5 +/- 3.4%. When calculated for body weight and time, UF was 3.0 +/- 0.3 ml/kg/hour. UF was not significantly different in patients requiring pressors versus those not requiring blood pressure support. Although minor ventilatory changes were required, significant deterioration of blood gases did not occur during the first 3-6 hours of PD, nor did significant changes in blood pressure develop. Hyperkalemia, present in 1 patient prior to PD, resolved using this regimen. Low volume PD was a viable alternative to hemodialysis or hemofiltration for control of hypervolemia in this small group of very ill infants and children.