Related Experiment Video
Updated: Jun 3, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Solutions for peritoneal dialysis in children: recommendations by the European Pediatric Dialysis Working Group
Claus Peter Schmitt1, Sevcan A Bakkaloglu, Günter Klaus
1Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, INF 430, 69120 Heidelberg, Germany. claus.peter.schmitt@med.uni-heidelberg.de
Insights
This guide offers recommendations for pediatric peritoneal dialysis (PD) fluid selection, emphasizing minimal glucose and tailored sodium and calcium balances. It advises on icodextrin use and highlights the benefits of bicarbonate-based fluids with reduced glucose degradation products (GDP).
Area of Science:
- Nephrology
- Pediatrics
- Biochemistry
Background:
- Peritoneal dialysis (PD) fluid choice is critical for pediatric patients.
- Specific fluid considerations are needed for infants, growing children, and adolescents undergoing PD.
Purpose of the Study:
- To provide evidence-based recommendations for selecting peritoneal dialysis fluids in children.
- To guide clinicians in optimizing PD fluid management for pediatric patients.
Main Methods:
- Systematic literature review of experimental and clinical studies on PD solutions in children and adults.
- Consensus discussions within the European Pediatric Dialysis Working Group.
- Grading of recommendations based on KDIGO nomenclature.
Main Results:
- Recommend using the lowest possible glucose concentration.
- Icodextrin is suggested for children with insufficient ultrafiltration during long dwells.
- Close monitoring of sodium chloride balance is crucial, especially in infants and anuric adolescents.
- Dialysate calcium should be adapted for a positive calcium balance in growing children.
- Amino acid-based fluids show good tolerability but limited anabolic effect; enteral nutrition is preferred.
- Peritoneal dialysis fluids with reduced glucose degradation products (GDP) are preferred due to lower toxicity.
- Bicarbonate-based fluids are superior for correcting metabolic acidosis compared to lactate-based solutions.
Conclusions:
- Tailoring PD fluid composition, including glucose, sodium, calcium, and buffer type, is essential for pediatric patients.
- Reduced GDP fluids and bicarbonate-based solutions offer significant advantages.
- Further research is needed for definitive recommendations on low GDP solutions with varying buffer compositions.
Abstract:
The purpose of this article is to provide recommendations on the choice of peritoneal dialysis (PD) fluids in children by the European Pediatric Dialysis Working Group. The literature on experimental and clinical studies with PD solutions in children and adults was analyzed together with consensus discussions within the group. A grading was performed based on the international KDIGO nomenclature and methods. The lowest glucose concentration possible should be used. Icodextrin may be applied once daily during the long dwell, in particular in children with insufficient ultrafiltration. Infants on PD are at risk of ultrafiltration-associated sodium depletion, while anuric adolescents may have water and salt overload. Hence, the sodium chloride balance needs to be closely monitored. In growing children, the calcium balance should be positive and dialysate calcium adapted according to individual needs. Limited clinical experience with amino acid-based PD fluids in children suggests good tolerability. The anabolic effect, however, is small; adequate enteral nutrition is preferred. CPD fluids with reduced glucose degradation products (GDP) content reduce local and systemic toxicity and should be preferred whenever possible. Correction of metabolic acidosis is superior with pH neutral bicarbonate-based fluids compared with single-chamber, acidic, lactate-based solutions. Prospective comparisons of low GDP solutions with different buffer compositions are still few, and firm recommendations cannot yet be given, except when hepatic lactate metabolism is severely compromised.
Related Concept Videos
01:30Peritoneal Dialysis I: Introduction and Procedure
01:25Peritoneal Dialysis III: Nursing Management
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:20Acute Kidney Injury V: Interprofessional Care
01:30Extracorporeal Removal of Drugs: Peritoneal Dialysis and Hemodialysis
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion