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Modification of peritoneal ultrafiltration capacity in children undergoing peritoneal dialysis
Insights
Continuous ambulatory peritoneal dialysis (CAPD) can lead to decreased ultrafiltration capacity in children. Intermittent ambulatory peritoneal dialysis (IAPD) and intermittent cycling peritoneal dialysis (ICPD) may preserve peritoneal membrane function.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Peritoneal Dialysis
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for pediatric end-stage renal disease.
- Long-term CAPD may affect peritoneal membrane function, specifically ultrafiltration capacity.
- The impact of different peritoneal dialysis modalities on pediatric patients requires further investigation.
Purpose of the Study:
- To evaluate the effect of long-term CAPD on peritoneal ultrafiltration capacity (PUFC) in children.
- To compare the efficacy of CAPD with intermittent ambulatory peritoneal dialysis (IAPD) and intermittent cycling peritoneal dialysis (ICPD) in preserving PUFC.
Main Methods:
- Eleven pediatric patients (ages 2.5 to 17.8 years) were treated with CAPD using standard dialysate solutions.
- Peritoneal ultrafiltration capacity, urea, and creatinine clearances were monitored over time.
- Four patients transitioned from CAPD to IAPD or ICPD to assess recovery of PUFC.
Main Results:
- Progressive decrease in PUFC was observed in all children undergoing CAPD.
- Five children developed membrane failure with negative ultrafiltration; one experienced peritonitis.
- Transitioning to IAPD or ICPD resulted in a significant increase in PUFC within one month.
Conclusions:
- Long-term CAPD is associated with a decline in peritoneal ultrafiltration capacity in pediatric patients.
- IAPD and ICPD may be superior to CAPD for maintaining peritoneal membrane function.
- Shorter dwell times and rest periods in IAPD/ICPD may preserve ultrafiltration capacity and prevent peritoneal deterioration.
Abstract:
Eleven children (7 girls and 4 boys) 2 1/2 to 17 years and 8 months of age were treated with CAPD for periods ranging from 6 to 31 months. All children were treated with commercially available dialysate solutions containing lactate. Peritoneal ultrafiltration capacity (PUFC) decreased progressively in all children without accompanying decrease in peritoneal urea and creatinine clearances. Five children developed membrane failure with negative ultrafiltration. One episode of peritonitis occurred in one of these 5 children and in 4 of them only 1.5% glucose solutions had been used. After an initial period (ranging from 14 to 31 months) of CAPD, 2 children were treated with Intermittent Ambulatory Peritoneal Dialysis (IAPD) and two others with Intermittent Cycling Peritoneal Dialysis (ICPD). In these 4 children, PUFC increased within one month from -3.75 ml/kg/day to + 5 ml/kg/day. By providing a shorter dwell time, IAPD and ICPD may allow a reduction in net inward transport of glucose, the maintenance of osmolar gradient and preservation of ultrafiltration capacity. Furthermore, periods of rest may allow some recovery from the progressive deterioration of the peritoneum resulting from long-term irrigation of the peritoneal cavity. These results indicate that IAPD and CPD may be superior to CAPD to maintain the ultrafiltration capacity of the peritoneum.