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Measurement of peritoneal fluid handling in children on continuous ambulatory peritoneal dialysis using dextran 70
R E Reddingius1, C H Schröder, J L Willems
1Department of Paediatrics, Sint Radboud University Hospital, Nijmegen, The Netherlands.
Insights
Fluid kinetics in children on continuous ambulatory peritoneal dialysis (CAPD) are similar to adults. Higher glucose concentrations increase ultrafiltration, but younger children have lower rates due to smaller dwell volumes.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Dialysis Therapy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for kidney failure.
- Understanding fluid kinetics in pediatric CAPD patients is crucial for optimizing treatment.
- Previous studies have primarily focused on adult fluid kinetics during CAPD.
Purpose of the Study:
- To investigate and compare fluid kinetics in children undergoing CAPD with those in adults.
- To assess the impact of different glucose concentrations on transcapillary ultrafiltration and marker clearance.
- To explore the relationship between patient age and fluid kinetic parameters in pediatric CAPD.
Main Methods:
- Studied fluid kinetics in children aged 2-15 years on CAPD.
- Utilized Dextran 70 as a volume marker to approximate lymphatic absorption.
- Measured transcapillary ultrafiltration and marker clearance over a 4-hour dwell period with varying glucose concentrations (1.36% and 3.86%).
Main Results:
- Transcapillary ultrafiltration and marker clearance in children were comparable to adult values when corrected for body surface area.
- Higher glucose concentration (3.86%) significantly increased transcapillary ultrafiltration (829 ml/4h/1.73m²) compared to lower concentration (250 ml/4h/1.73m²).
- A positive correlation was observed between age and transcapillary ultrafiltration in children receiving 3.86% glucose dialysate (r=0.69, P=0.009).
Conclusions:
- Fluid kinetics in pediatric and adult CAPD patients are similar when normalized for body surface area.
- Lower transcapillary ultrafiltration in younger children may be attributed to a low dwell volume relative to peritoneal surface area.
- Dialysate glucose concentration plays a significant role in modulating ultrafiltration in pediatric CAPD.
Abstract:
Fluid kinetics were studied in children treated with continuous ambulatory peritoneal dialysis (CAPD) aged between 2 and 15 years. Dextran 70 was used as a volume marker. A 4-h dwell was studied with a dwell volume of 40 mg/kg. Transcapillary ultrafiltration was measured as well as marker clearance, which is the best available approximation of lymphatic absorption in the clinical setting. In 11 children in whom dialysate was used containing 1.36% glucose transcapillary ultrafiltration was 250 +/- 79 ml/4 h/1.73 m2 and marker clearance 236 +/- 101 ml/4 h/1.73 m2. In 13 children dialysed with 3.86% glucose, transcapillary ultrafiltration was 829 +/- 226 ml/4 h/1.73 m2 and marker clearance 307 +/- 176 ml/4 h/1.73 m2. These values are similar to those found in adult patients. There was a positive correlation between age and transcapillary ultrafiltration in the group receiving dialysate containing 3.86% glucose (r = 0.69, P = 0.009). There was no correlation between age and marker clearance. It is concluded that fluid kinetics in children and adults on CAPD are similar when corrected for body surface area. In young children transcapillary ultrafiltration is lower, probably because dwell volume is low in relation to peritoneal surface area in these children.