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Peritoneal clearances with different dialysis regimens in children undergoing continuous cycling peritoneal dialysis
H E Leichter1, I B Salusky, T von Lilien
1Department of Pediatrics, UCLA Center for the Health Sciences.
Insights
Hourly continuous cycling peritoneal dialysis (CCPD) offers the best solute clearance in children. Adding a daytime dwell improves clearance, especially for anuric patients, but may increase protein loss.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Dialysis Technology
Background:
- Peritoneal clearances and protein losses in pediatric patients on continuous cycling peritoneal dialysis (CCPD) are not well-defined.
- Understanding these parameters is crucial for optimizing treatment and nutritional status in children with kidney disease.
Purpose of the Study:
- To evaluate the impact of different CCPD regimens on peritoneal clearances and dialysate protein losses in pediatric patients.
- To compare solute removal efficiency and protein wasting across various CCPD protocols.
Main Methods:
- Ten pediatric patients on home peritoneal dialysis were studied over 48 hours in a Clinical Research Center.
- Five different CCPD protocols were tested, varying exchange frequency and including a daytime dwell option.
- BUN and creatinine clearances were calculated, and dialysate protein losses were measured using standardized dialysate volumes and glucose concentrations.
Main Results:
- Hourly night-time dialysis (Protocol I) demonstrated the highest solute clearance.
- Incorporating a daytime dwell significantly enhanced total solute clearance, particularly beneficial for anuric patients.
- Protein losses were highest with low-frequency exchanges and the addition of a daytime dwell.
- No significant changes in serum albumin were observed during the study, but long-term nutritional effects require further investigation.
Conclusions:
- CCPD regimens with higher exchange frequency and daytime dwells can optimize solute clearance in pediatric patients.
- Careful consideration of CCPD protocol is necessary to balance solute removal efficiency with potential protein losses.
- Further research is needed to assess the long-term nutritional consequences of protein loss in children undergoing CCPD.
Abstract:
Peritoneal clearances and dialysate protein losses occurring in paediatric patients undergoing different continuous cycling peritoneal dialysis (CCPD) regimens have not been well defined. We, therefore, evaluated 10 children aged 15.8 +/- 2.5 (SD) years who were maintained on home peritoneal dialysis for 20.5 +/- 10 months. All patients had at least 3 months of CCPD. The patients were admitted to the Clinical Research Center for 48 hours and allocated to five different dialysis protocols. In protocol I, the frequency of exchanges was 10 per 10 hours; in Protocol II it was 5 per 10 hours; and in Protocol III it was 3 per 10 hours. Protocol II D and III D had, in addition, a daytime dwell of one-half the night-time volume. A 1.5% glucose dialysate solution was used for night-time dialysis, and 4.25% glucose dialysate solution for the daytime dwell. The mean inflow dialysate volume per exchange was 36.7 +/- 5.6 ml/kg body weight and was constant in each patient for each study protocol. BUN and creatinine clearances for each protocol were calculated and dialysate protein losses were measured. The data indicate that hourly night-time dialysis (Protocol I) provides best solute clearance. A daytime dwell further enhances the total solute clearance and should be used preferably in anuric patients. Residual urine output contributes significantly to the total solute clearance. Protein losses are maximum with low-frequency exchanges and a daytime dwell. No significant differences in the serum albumin concentrations were found during the different protocols; however, the long-term effect of the protein loss on the nutritional status of the patients requires further evaluation.