Continuous peritoneal dialysis in children: past, present and future

Area of Science:

• Pediatric Nephrology
• Renal Replacement Therapy
• Dialysis Technology

Background:

• Continuous peritoneal dialysis (CPD) has been a vital renal replacement therapy (RRT) for children since 1978.
• Initial use of Continuous Ambulatory Peritoneal Dialysis (CAPD) evolved to include infants, followed by the introduction of Automated Peritoneal Dialysis (APD) in the 1980s.
• Currently, CPD is the primary RRT for pediatric patients, with APD managing three-quarters of these cases.

Purpose of the Study:

• To review the evolution and current status of CPD in pediatric end-stage renal disease (ESRD) management.
• To highlight key developments, challenges, and future directions in pediatric CPD.
• To assess CPD as a practical and cost-effective RRT option for children.

Main Methods:

• Review of historical data and clinical practice evolution in pediatric CPD.
• Analysis of advancements in patient management, including growth, nutrition, renal osteodystrophy, anemia, and training.
• Identification of common complications and emerging strategies for improvement.

Main Results:

• Significant progress has been made in managing growth, nutrition, renal osteodystrophy, and anemia in pediatric CPD patients.
• Peritonitis, hernias, and stress remain significant challenges in CPD management.
• APD is the predominant method, indicating a shift towards automated systems in pediatric RRT.

Conclusions:

• Continuous peritoneal dialysis, particularly APD, is the predominant and most practical RRT for children with ESRD.
• Future research should focus on enhancing dialysis adequacy, improving dialysis solutions and fluids, and reducing peritonitis rates.
• Despite challenges, CPD offers a cost-effective and feasible dialysis therapy for pediatric populations.