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Kinetics of peritoneal dialysis in children: role of lymphatics

R A Mactier1, R Khanna, H Moore

  • 1Department of Medicine, University of Missouri Health Sciences Center, Columbia.

Kidney International
|July 1, 1988
PubMed

Insights

Lymphatic absorption significantly impacts peritoneal dialysis in children. This process reduces fluid removal and solute clearance more than in adults, affecting treatment effectiveness.

Area of Science:

  • Nephrology
  • Physiology

Background:

  • Peritoneal fluid is continuously absorbed by peritoneal cavity lymphatics.
  • Understanding lymphatic absorption is crucial for optimizing peritoneal dialysis (PD).

Purpose of the Study:

  • To evaluate the role of lymphatic absorption in the kinetics of peritoneal dialysis in children.
  • To compare lymphatic absorption and its effects in children versus adults undergoing PD.

Main Methods:

  • Standardized four-hour peritoneal dialysis exchanges were performed in six children.
  • A 2.5% dextrose dialysis solution was used at 40 ml/kg.
  • Measurements included fluid absorption, ultrafiltration, and solute clearances.

Main Results:

  • Children exhibited significant cumulative lymphatic absorption (10.4 +/- 1.6 ml/kg), reducing net ultrafiltration by 73 +/- 10%.
  • Lymphatic absorption decreased potential daily drain volumes by 27 +/- 5% and solute clearances by 22-24% in children.
  • Children showed more rapid urea equilibration, greater glucose absorption, and lower net ultrafiltration compared to adults.

Conclusions:

  • Lymphatic absorption plays a major role in peritoneal dialysis kinetics in children.
  • The rate of lymphatic absorption causes a proportionally greater reduction in net ultrafiltration and solute clearance in children than in adults.
  • These findings highlight the need to consider lymphatic absorption when managing PD in pediatric patients.

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