Are current peritoneal dialysis solutions adequate for pediatric use?

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.