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Are current peritoneal dialysis solutions adequate for pediatric use?

Enrico Eugenio Verrina, Rossella Cannavò, Betti Schaefer

    Contributions to Nephrology
    |June 2, 2012
    PubMed

    Insights

    New peritoneal dialysis (PD) fluids aim to preserve kidney function in children undergoing long-term renal replacement therapy. These advanced PD solutions offer improved biocompatibility, crucial for pediatric patients awaiting kidney transplants.

    Area of Science:

    • Nephrology
    • Pediatric Nephrology
    • Biocompatible Materials Science

    Background:

    • Peritoneal dialysis (PD) is a primary treatment for pediatric end-stage renal disease (CKD5D) patients awaiting transplantation.
    • Conventional PD fluids can cause significant peritoneal membrane damage over time.
    • Preserving peritoneal membrane function is vital for long-term treatment success in children.

    Purpose of the Study:

    • To review the scientific evidence on advanced PD solutions with improved biocompatibility.
    • To evaluate the potential benefits of these novel PD fluids in pediatric patients.
    • To focus on solutions designed to minimize peritoneal membrane alterations.

    Main Methods:

    • Review of in vitro, experimental, and clinical studies on advanced PD fluid formulations.
    • Analysis of recommendations from the European Pediatric Dialysis Working Group.
    • Evaluation of specific PD fluid components like icodextrin, amino acids, and bicarbonate.

    Main Results:

    • Low glucose degradation product (GDP) PD solutions are recommended to preserve peritoneal membrane integrity.
    • Icodextrin may benefit children with fluid overload, though ultrafiltration can be limited in infants.
    • Bicarbonate-based PD fluids aid in managing metabolic acidosis, especially in acute kidney injury.

    Conclusions:

    • Advanced PD solutions, including those with reduced GDPs, icodextrin, and bicarbonate, show promise for preserving peritoneal membrane function in pediatric CKD5D.
    • These biocompatible PD fluids represent a significant improvement over conventional options for long-term pediatric renal replacement therapy.
    • Further research is needed to fully elucidate the benefits of amino acid-based PD fluids in malnourished pediatric populations.

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