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Comparative role of PET and Kt/V determination in pediatric chronic peritoneal dialysis
Andreia Watanabe1, Vivian V Lanzarini, Ulisses D Filho
1Pediatric Nephrology, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas of São Paulo, University Medical School, Sao Paulo, Brazil. andwata@terra.com.br
Insights
Pediatric peritoneal dialysis (PD) patients easily achieve high small solute removal, but this doesn't guarantee optimal clinical management or adequate growth and nutritional status. Careful monitoring is essential for successful chronic PD treatment.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Chronic Kidney Disease Management
Background:
- Nutritional status and growth are key prognostic indicators for chronic peritoneal dialysis (PD) adequacy in children.
- Achieving euvolemia, blood pressure control, and metabolic/electrolytic balance are critical treatment goals in pediatric PD.
Purpose of the Study:
- To detail chronic PD prescription parameters in a cohort of pediatric patients.
- To compare achieved hemodynamic, anthropometric, and PD adequacy results against existing literature benchmarks.
Main Methods:
- Retrospective analysis of clinical records for 30 pediatric patients on PD for over six months (January 1998 - May 2005).
- Evaluation included prescription parameters, peritoneal membrane transport characteristics, and clinical outcomes.
Main Results:
- The cohort included 56.7% boys; 66.7% had chronic kidney disease secondary to uropathy.
- High small solute removal (weekly urea Kt/V > 2.1) was observed in all patients.
- Despite antihypertensive use, 5/30 patients had blood pressure above the 95th percentile, particularly those with glomerulopathy-related CKD.
Conclusions:
- Pediatric PD patients readily achieve elevated small solute removal indexes.
- High solute removal alone does not equate to optimal clinical management or patient outcomes.
Introduction:
Nutritional state and growth are considered as prognostic markers of chronic peritoneal dialysis (PD) adequacy in pediatric patients. The euvolemia, blood pressure control, and metabolic and electrolytic equilibrium are parameters to be achieved by PD treatment.
Objective:
To describe the chronic PD prescription parameters of a cohort of pediatric patients and to compare the obtained hemodynamic, antrophometric and adequacy results with those suggested by the literature.
Methods:
Retrospective analysis based on clinical records evaluation of 30 pediatric patients undergoing PD for more than 6 months from January 1998 to May 2005.
Results:
In the present study, 17/30 (56.7%) were boys. Chronic kidney disease was secondary to uropathy in 66.7% of the cases. The infusion volume was > 1,000 ml/m2 in 9 patients. The peritoneal membrane was characterized as high (27.8%), high-average (33.3%), low-average (22.2%) and low transporter (16.7%). The weekly urea Kt/V was > 2.1 in all the evaluated patients. Blood pressure parameters above the 95th percentile despite the use of antihypertensive medication were observed in 5/30 patients, four of whom with CKD secondary to glomerulopathy. The initial and final Body Mass Index and weight for height ratio were preserved in 83.3% (25/30) patients.
Conclusion:
Elevated indexes of small solutes removal are easily attained in pediatric PD patients and do not imply optimal clinical management do not imply optimal climanagement.
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