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Peritoneal dialysis in children: consider the membrane for optimal prescription

M Fischbach1, C Dheu, A C Michallat

  • 1Pediatry 1, University Hospital, Avenue Moliere, 67098 Strasbourg Cedex, France.

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
|January 23, 2008
PubMed

Insights

Individualizing peritoneal dialysis (PD) prescriptions, particularly fill volume and dwell times, optimizes treatment for patients. New PD fluids enhance membrane function and preserve vascular health.

Area of Science:

  • Nephrology
  • Biomedical Engineering

Background:

  • Peritoneal dialysis (PD) prescriptions were historically empirical, especially for continuous ambulatory peritoneal dialysis (CAPD).
  • Advancements in understanding the peritoneal membrane enable personalized PD prescriptions, particularly for automated peritoneal dialysis (APD) in children.

Purpose of the Study:

  • To establish evidence-based guidelines for optimizing peritoneal dialysis prescription parameters.
  • To explore the impact of fill volume, dwell times, and new PD fluid formulations on treatment efficacy and patient outcomes.

Main Methods:

  • Prescribing fill volume based on body surface area (mL/m(2)).
  • Utilizing intraperitoneal pressure measurement (IPP; cm H2O) for safe fill volume optimization.
  • Individualizing dwell times based on solute clearance and ultrafiltration needs.
  • Evaluating new peritoneal dialysis fluids free of GPDs, with neutral pH, and non-exclusively lactate buffering.

Main Results:

  • A peak fill volume of 1400-1500 mL/m(2) is suggested for optimal tolerance and efficiency.
  • Balancing dwell times is crucial: shorter times for solute clearance and ultrafiltration, longer times for phosphate clearance.
  • New PD fluid formulations support peritoneal membrane recruitment and preserve peritoneal vascular hyperperfusion.

Conclusions:

  • Individualized peritoneal dialysis prescriptions, considering fill volume and dwell times, improve treatment.
  • Optimized fill volumes and tailored dwell times enhance solute clearance and ultrafiltration.
  • Novel PD fluids offer benefits for peritoneal membrane health and vascular function.

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