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Intraperitoneal pressure measurements in children: a retrospective study
Anne-Louise Sawaya1, Ivan Damgov2, Soraya Menouer3
1Service de pédiatrie 2, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, Strasbourg, France
Insights
Intraperitoneal pressure (IPP) measurements in children undergoing peritoneal dialysis (PD) are generally acceptable but show high variability. Further research is needed to correlate IPP with patient outcomes.
Area of Science:
- Nephrology
- Pediatrics
- Dialysis
Background:
- Peritoneal dialysis (PD) requires individualized regimens for optimal clinical tolerance and adequacy.
- Intraperitoneal pressure (IPP) measurements are proposed for determining optimal intraperitoneal dialysate volume (IPV), but routine clinical data are limited.
Purpose of the Study:
- To evaluate the applicability and variability of routine intraperitoneal pressure (IPP) measurements in children on automated peritoneal dialysis (APD).
- To assess the relationship between IPP, intraperitoneal dialysate volume (IPV), and PD-related complications in a pediatric population.
Main Methods:
- Retrospective analysis of 655 monthly IPP measurements from 21 children on stable automated PD.
- IPP was measured during daytime (IPP1) and nighttime (IPP2) dwell volumes using various dialysis fluids.
- Measurements were correlated with PD-related complications and Kt/V.
Main Results:
- Mean IPP was 11.0 ± 2.6 cmH2O, with higher values observed during nighttime dwells (IPP2) compared to daytime dwells (IPP1).
- IPP increased with higher fill volumes per body surface area (BSA).
- Significant intra- and interindividual variability in IPP was noted with single fill volume measurements.
Conclusions:
- IPP values were acceptable in the studied pediatric population.
- Higher fill volumes correlated with higher IPP.
- The clinical significance of IPP variability and its direct relation to patient outcomes remains uncertain.
Background:
The peritoneal dialysis (PD) regimes should be individualized based on clinical tolerance and adequacy. Routine hydrostatic intraperitoneal pressure (IPP) measurements have been suggested to define optimal intraperitoneal dialysate volume (IPV), data on applicability and variability in clinical routine are few.
Methods:
We retrospectively analysed 655 IPP measurements monthly performed in 21 children on stable automated PD. IPP was measured with the day-time dwell volume (IPV 606 ± 303 mL/m2) after two-hour dwell time (IPP1; n = 430), and again with the night-time dwell volume (IPV 958 ± 274 mL/m2) after 10 min dwell time (IPP2; n = 225), using bicarbonate (BPDF) and lactate buffered (LPDF) low GDP fluids and icodextrin fluid (IPDF), respectively. Findings were related to PD related complications and Kt/V.
Results:
Mean of all IPP measurements was 11.0 ± 2.6 cmH2O or 2.1 ± 0.8 cmH2O/100 mL/m2, with a mean IPV of 7.3 ± 3.4 mL/100 mL/m². Mean IPP1 was 10.3 ± 2.2 cmH2O, corresponding to 6.1 ± 3.1 mL/100 mL/m² IPV, IPP2 was 12.5 ± 2.5 cmH2O, corresponding to 9.6 ± 2.6 mL/100 mL/m² IPV (IPP1 vs IPP2 p < 0.0001).
Conclusion:
The values of IPP were acceptable in this pediatric population. IPP is relatively higher with higher fill volumes per BSA. Using single fill volume IPP measurements provides IPP with high intra- and interindividual variability. The relation to patient outcome is uncertain.
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