[Continuous ambulatory peritoneal dialysis in children. 2 years' experience]

Four children aged 6-10 years (body weight 20-31 kg) and one adolescent patient (age 17 years, 32 kg) were treated by continuous ambulatory peritoneal dialysis (CAPD) over periods of 4-14 months totalling 39 months. Dialysis volumes of 1 liter for the pediatric patients and 1.5 liters for the adolescent patient were exchanged four times daily: glucose concentration was 15 milligrams during three cycles and 42.5 milligrams during one cycle. Bag exchanges and general care of the younger patients were primarily carried out by their mothers. Overall rehabilitation and patients' acceptance were good despite several complications, but full school attendance was only achieved in 2 children. Uremia and fluid balance were well controlled despite minimal dietary restrictions. Average serum urea was 20 mmol/l and creatinine 700 mumol/l. Glucose reabsorption from dialysate was 1-4 g/kg per day. Bacterial peritonitis occurred six times and responded well to appropriate treatment. Its incidence decreased from one episode every 4-5 months (before July 1980) to one every 8 months. Protein losses in the dialysate were 0.10-0.17 g/kg per day in 4 children; the serum protein was 57-69 milligrams. One child with sterile peritonitis lost 0.46 g protein per kg per day and became frankly hypoproteinemic (47 micrograms). Technical problems included cuff erosion (3 cases), and dislocation (1) or malposition (1) of the Tenckhoff catheter. Statural growth was unsatisfactory in 2 children treated for more than 9 months. CAPD was terminated by cadaveric renal transplantation in 3 patients, and by recovery of renal function in one. One patient is still on CAPD. CAPD offers a valuable alternative to hemodialysis in selected pediatric patients. However, the choice between the two methods should be left to specialized child centers. The long-term potential of CAPD still remains to be defined.