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Published on: July 19, 2018
Continuous flow peritoneal dialysis (CFPD) improves ultrafiltration in children with acute kidney injury on
Peter Nourse1, Gina Sinclair2, Priya Gajjar2
1Division of Paediatric Nephrology, Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein road, Rondebosch, Cape Town, 7700, South Africa. peter.nourse@uct.ac.za.
Insights
Continuous flow peritoneal dialysis (CFPD) significantly improved ultrafiltration (UF) and solute clearance in infants with acute kidney injury (AKI) when conventional peritoneal dialysis (PD) was insufficient. CFPD offers a promising alternative for fluid management in pediatric AKI.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Critical Care Medicine
Background:
- Conventional peritoneal dialysis (PD) has limitations in achieving adequate ultrafiltration (UF) and clearance in pediatric acute kidney injury (AKI).
- Extracorporeal techniques are often compared, but PD remains a vital option for fluid management in infants.
Purpose of the Study:
- To evaluate the efficacy of continuous flow peritoneal dialysis (CFPD) in improving UF in infants with AKI.
- To compare UF and solute clearance between CFPD and conventional PD in pediatric AKI patients with inadequate UF on standard PD.
Main Methods:
- Prospective study of five infants with AKI and fluid overload, serving as their own controls.
- Comparison of CFPD (2.5% glucose, 100 ml/min/1.73 m(2) dialysate flow) versus conventional PD.
- Measurement of UF and solute (urea, creatinine) clearance rates for both techniques.
Main Results:
- CFPD achieved significantly higher median UF rates (6.7 mg/kg/h) compared to conventional PD (1.7 mg/kg/h) (p=0.042).
- Solute clearances for urea and creatinine were substantially improved with CFPD (19 and 41 mL/min/1.73 m(2)) versus conventional PD (6.89 and 7.46 mL/min/1.73 m(2)) (p=0.043).
Conclusions:
- Continuous flow peritoneal dialysis is effective in enhancing ultrafiltration in fluid-overloaded infants with AKI.
- CFPD demonstrates superior performance over conventional PD for both fluid removal and solute clearance in this vulnerable pediatric population.
Background:
Criticism against the use of acute peritoneal dialysis (PD) has been its low clearance and low ultrafiltration (UF) volumes compared to extracorporeal techniques. The aim of our study was to determine whether continuous flow peritoneal dialysis (CFPD) would improve UF in children with acute kidney injury (AKI) in cases where UF on conventional PD was inadequate using 4.25 % glucose concentrations.
Methods:
Five infants were prospectively studied. All had AKI with fluid overload. The median age of the patients was 6 (range 0.43-9) months; the median weight was 6.5 (range 2.7-8.4) kg. Each patient served as his or her own control, undergoing both CFPD and conventional PD. CFPD was performed with two bedside-placed catheters using a 2.5 % glucose concentration. After initial filling, a dialysate flow rate of 100 ml/min/1.73 m(2) was maintained with an adapted continuous venovenous haemofiltration machine. The UF flow rate was set at 2.5 ml/min/1.73 m(2) and adapted as necessary. UF and clearance rates were measured for both PD and CFPD.
Results:
The median UF rate achieved was 1.7 (range 0.01-5.30) mg/kg/h with conventional PD versus 6.7 (range 2.17-15.7) mg/kg/h with CFPD (p = 0.042). The clearances of urea and creatinine were 6.89 (range 4.50-7.55) and 7.46 (range 4.79-10.50) mL/min/1.73 m(2), respectively, with conventional PD and 19 (17.0-30.0) and 41 (standard deviation17.4, range 12.0-52.0) mL/min/1.73 m(2), respectively, with CFPD (both p = 0.043).
Conclusion:
Continuous flow peritoneal dialysis improves UF in fluid overloaded infants who are not achieving adequate UF on conventional PD.
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