Intra-abdominal pressure in children receiving peritoneal dialysis for acute kidney injury

BackgroundCritically ill children on peritoneal dialysis (PD) are at an increased risk of raised intra-abdominal pressure (IAP). The aim of this study was to describe IAP and complications with a standard PD fill volume, using conventional PD and continuous flow PD (CFPD) in critically ill children with acute kidney injury. A secondary objective was to compare two IAP measurement techniques, which were direct measurement from the PD catheter via a manometer and indirect measurement via the bladder catheter to a transducer.MethodThis study was a secondary analysis of a previously published randomized controlled crossover trial. Within- and between-group changes in IAP, blood pressure and ventilation parameters were analysed using paired t-tests. Bland-Altman and intraclass correlation tests were used to assess agreement between direct and intravesicular measurement of IAP.ResultsFifteen participants (median (range) age and weight 6.0 (0.2-14) months and 5.8 (2.3-14.0) kg) were included, of which 9 (60%) had raised IAP (>10 mmHg) after filling. No children developed compartment syndrome or other complications. Mean ± standard deviation IAP on conventional versus CFPD was 9.35 ± 2.97 and 11.5 ± 2.96 versus 9.3 ± 3.35 and 11.2 ± 3.62 when measured directly and indirectly, respectively (p > 0.5). Intravesicular measurement of IAP was constantly significantly higher compared to the direct method (p = 0.002); however, there was good correlation (Pearson correlation coefficient 0.7; p < 0.001) and moderate reliability (ICC = 0.6) between the methods.ConclusionIncreased IAP (>10 mmHg) was common, although not associated with serious adverse events, and warrants monitoring in these patients. The pressures measured are different with the two techniques used, although they do correlate well. More studies are needed to define increased IAP depending on the measuring technique and inform IAP measurement practice in children with acute PD.