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Residual renal function in children treated with continuous ambulatory peritoneal dialysis or automated peritoneal
Maria Roszkowska-Blaim1, Piotr Skrzypczyk, Dorota Drozdz
1Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland. dblaim@o2.pl
Insights
Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) influence residual renal function (RRF) in children. RRF was better preserved in children with glomerulopathy or hereditary diseases, particularly with CAPD.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Mode of dialysis significantly impacts patient outcomes in pediatric end-stage renal disease.
- Understanding the influence of continuous ambulatory peritoneal dialysis (CAPD) versus automated peritoneal dialysis (APD) on residual renal function (RRF) is crucial for treatment strategies.
- Residual renal function preservation is a key factor in long-term outcomes for children undergoing dialysis.
Purpose of the Study:
- To assess the influence of CAPD and APD on residual renal function (RRF) in pediatric patients.
- To compare key clinical and biochemical parameters between children treated with CAPD and APD.
- To identify factors influencing RRF preservation in children undergoing peritoneal dialysis.
Main Methods:
- Retrospective analysis of 30 children (15 on CAPD, 15 on APD) treated for at least 12 months.
- Evaluation of parameters including 24-hour urine output, residual glomerular filtration rate (GFR), dialysis adequacy (Kt/V, creatinine clearance), and biochemical markers.
- Correlation analysis between dialysate volume, treatment duration, residual diuresis, and serum albumin.
Main Results:
- While not statistically significant (p=0.06), residual GFR showed a trend towards being higher in the APD group after 12 months.
- Dialysis adequacy was comparable between CAPD and APD, but APD utilized a higher dialysate volume (p < 0.01).
- Residual renal function was better preserved in children with glomerulopathy or familial/hereditary renal diseases, particularly those on CAPD.
Conclusions:
- Residual renal function appears better preserved in children with glomerulopathy or hereditary renal diseases, especially when treated with CAPD.
- While APD uses higher dialysate volumes, RRF preservation trends were not significantly different from CAPD in this cohort.
- Further research with larger patient groups is warranted to confirm these findings regarding RRF in pediatric peritoneal dialysis.
Abstract:
Our study assessed the influence of mode of dialysis [continuous ambulatory peritoneal dialysis (CAPD) or automated peritoneal dialysis (APD)] on residual renal function (RRF). The study retrospectively examined 30 children [15 on CAPD, mean age: 8.85 +/- 5.15 years; and 15 on APD, mean age: 10.17 +/- 3.63 years (nonsignificant)], followed for at least 12 months, for whom these methods were initial mode of treatment. Arterial hypertension was found in 80% of the children on CAPD and in 67% on APD. Parameters that were analyzed included 24-hour urine output; residual glomerular filtration rate (GFR); adequacy based on total weekly Kt/V urea and creatinine clearance; and hemoglobin, total protein, serum albumin, daily proteinuria, medications used, and causes of end-stage renal disease. After 12 months of decline in urine output, residual GFR was higher in children on APD (p = 0.06, nonsignificant). The difference in adequacy between CAPD and APD was nonsignificant, but a higher volume of dialysate was used in APD (p < 0.01). Proteinuria was present in 9 children on CAPD and in 6 on APD. In CAPD, we observed a negative correlation between the volume of dialysate and duration of treatment (p < 0.01, r = -0.79); in APD, a positive correlation (p < 0.0001, r = 0.89) was observed. In APD, we observed negative correlations between residual diuresis and duration of treatment (p < 0.0001, r = -0.9), serum albumin (p < 0.05, r = -0.6), and volume of dialysate (p < 0.001, r = -0.83). Residual renal function was better preserved in children with a glomerulopathy or a familial or hereditary renal disease than in those with pyelonephritis. Our results suggest that RRF is better preserved in children with a glomerulopathy or a familial or hereditary renal disease, especially in those treated with CAPD. Further studies are needed in larger groups of patients.
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