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Sodium removal per ultrafiltration volume in automated peritoneal dialysis in pediatric patients

Takashi Tokunaga1,2, Riku Hamada3,4, Tomohiro Inoguchi1,5

  • 1Department of Nephrology and Rheumatology, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.

Pediatric Nephrology (Berlin, Germany)
|May 2, 2024
PubMed

Insights

Pediatric automated peritoneal dialysis (APD) removes less sodium than standard adult CAPD, especially with short dwell times. Salt intake restriction and longer dwells are recommended for anuric pediatric patients on APD.

Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Dialysis Technology

Background:

  • Standard sodium removal in adult continuous ambulatory peritoneal dialysis (CAPD) is 7.5 g/L ultrafiltration volume (UFV).
  • Automated peritoneal dialysis (APD) is common in pediatric patients, but sodium removal in this population is not well-established.
  • This study addresses the gap in understanding sodium removal during pediatric APD.

Purpose of the Study:

  • To estimate sodium removal per UFV in pediatric patients undergoing APD.
  • To correlate sodium removal with peritoneal equilibrium test (PET) categories and dwell times.
  • To provide recommendations for optimizing sodium balance in pediatric APD.

Main Methods:

  • Retrospective cohort study of pediatric APD patients (July 2010-November 2017) at Tokyo Metropolitan Children's Medical Center.
  • Analysis of 217 samples from 18 patients, categorized by PET results (High, High-average, Low-average).
  • Calculation of sodium removal per UFV using effluent samples from 1-, 2-, 4-, and 10-hour dwell times.

Main Results:

  • Sodium removal per UFV varied significantly with PET category and dwell time.
  • For High PET category, sodium removal ranged from 5.2 g/L (1-hr dwell) to 11.5 g/L (10-hr dwell).
  • For Low-average PET category, sodium removal ranged from 4.6 g/L (1-hr dwell) to 7.1 g/L (10-hr dwell).

Conclusions:

  • Pediatric APD demonstrates lower sodium removal per UFV compared to adult CAPD standards.
  • Shorter dwell times in pediatric APD are associated with reduced sodium removal, potentially leading to sodium accumulation.
  • Recommendations include dietary salt restriction and incorporating longer daytime dwells for pediatric APD patients, particularly anuric individuals.
Abstract

Keywords:
Automated peritoneal dialysisDwell timeNa sievingPeritoneal equilibrium testSodium removal

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