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Comparison of continuous cycling peritoneal dialysis with continuous ambulatory peritoneal dialysis in children
Insights
Continuous cycler-assisted peritoneal dialysis (CCPD) offers adequate uremia control in pediatric patients, though serum creatinine levels remain higher than with continuous ambulatory peritoneal dialysis (CAPD). Further research into creatinine management is warranted.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Peritoneal dialysis is a vital treatment for pediatric end-stage renal disease.
- Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler-assisted peritoneal dialysis (CCPD) are common modalities.
- Comparing the efficacy and safety of CAPD and CCPD in children is crucial for optimizing treatment.
Purpose of the Study:
- To evaluate and compare the clinical courses of pediatric patients treated with CAPD and subsequently CCPD.
- To assess biochemical control, infectious complications, and mechanical issues associated with both CAPD and CCPD.
Main Methods:
- A cohort of 10 pediatric patients was retrospectively analyzed.
- Patients initially underwent CAPD, followed by CCPD, with clinical data collected over specified periods.
- Key parameters evaluated included biochemical markers (serum creatinine), peritonitis rates, exit site infections, and mechanical complications.
Main Results:
- CCPD demonstrated adequate control of uremic biochemical abnormalities, with the exception of serum creatinine.
- Serum creatinine levels were significantly higher during CAPD (9.7 ± 1.0 mg/dl) compared to CCPD (10.8 ± 0.9 mg/dl; P < 0.01).
- Peritonitis rates were higher during CCPD (1 episode/8.5 patient months) versus CAPD (1 episode/10.7 patient months), and exit site infections were also noted in both groups.
Conclusions:
- CCPD provides effective biochemical management for pediatric uremia, but serum creatinine control requires attention.
- While CCPD showed a trend towards higher peritonitis and exit site infection rates, mechanical complications like hernias and peritoneal leaks occurred in both CAPD and CCPD phases.
- The findings suggest CCPD is a viable option for pediatric peritoneal dialysis, with specific considerations for creatinine levels and infection surveillance.
Abstract:
The clinical courses in 10 pediatric patients undergoing CAPD for 15.0 +/- 2.8 months and subsequently CCPD for 9.3 +/- 3.2 months were evaluated. During CAPD patients received four or five daily exchanges, and during CCPD five 2-hour nocturnal cycles over 10 hours plus a diurnal dwell. The only significant biochemical difference during CAPD compared with CCPD was the serum creatinine concentration (9.7 +/- 1.0 mg/dl vs 10.8 +/- 0.9 mg/dl, P less than 0.01). The peritonitis rate was one episode every 10.7 patient months during CAPD, compared with one episode every 8.5 patient months during CCPD. There were 21 episodes of exit site infection during CAPD versus 17 during CCPD. Mechanical complications included five ventral hernias in three patients and six peritoneal leaks in three patients during CAPD; two patients had two hernias and two patients had two peritoneal leaks during CCPD. Our results indicate adequate control of the biochemical abnormalities of uremia with CCPD, with the exception of the serum creatinine concentration.