Related Experiment Videos
Dialysis delivery in children on nightly intermittent and tidal peritoneal dialysis
A Edefonti1, G Consalvo, M Picca
1Department of Paediatrics II, University of Milan, Italy.
Insights
Tidal peritoneal dialysis (TPD) offers improved dialysis efficiency in children compared to nightly intermittent peritoneal dialysis (NIPD). TPD achieved higher clearances and lower waste levels in less time, benefiting high transporters most.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Children with end-stage renal disease require effective dialysis for adequate waste removal.
- Peritoneal dialysis offers various modalities, including nightly intermittent peritoneal dialysis (NIPD) and tidal peritoneal dialysis (TPD).
- Patient transport characteristics, determined by the peritoneal equilibration test (PET), influence dialysis adequacy.
Purpose of the Study:
- To evaluate the efficacy of tidal peritoneal dialysis (TPD) in improving dialysis adequacy and reducing treatment time in pediatric patients.
- To compare TPD with nightly intermittent peritoneal dialysis (NIPD) in terms of solute clearances and patient outcomes.
- To determine optimal TPD prescriptions for enhanced dialysis efficiency.
Main Methods:
- A cohort of seven pediatric patients (5 high/high average, 2 low/low average transporters) were switched from NIPD to TPD.
- TPD prescriptions were adjusted to optimize dialysis flow rate, dwell time, and number of exchanges.
- Peritoneal and total clearances of urea and creatinine were measured, alongside serum levels of these waste products.
Main Results:
- TPD resulted in significantly higher dialysis flow rates compared to NIPD due to reduced dwell times and increased exchanges.
- Peritoneal and total clearances of urea and creatinine were significantly higher with TPD.
- Serum creatinine and urea nitrogen levels were lower during TPD, with a mean time-averaged blood urea nitrogen of 48.5 +/- 11.6 mg/dl.
- Treatment duration was shorter with TPD, despite a decrease in residual renal function.
- Improvements were more pronounced in high/high average transporters.
Conclusions:
- Tidal peritoneal dialysis (TPD) is an effective strategy for enhancing dialysis adequacy and reducing treatment time in pediatric patients.
- TPD offers superior solute clearance compared to NIPD, particularly in high transporters.
- TPD represents a valuable alternative for optimizing dialysis delivery in children with end-stage renal disease.
Abstract:
To achieve more adequate dialysis in a shorter treatment time, seven children, characterized as high/high average (H/HA, 5 patients) and low/low average (L/LA, 2 patients) transporters according to the peritoneal equilibration test, were treated with tidal peritoneal dialysis (TPD) for 13.7 +/- 5.7 months, after being treated with nightly intermittent peritoneal dialysis (NIPD) for a similar period. We determined the TPD prescription necessary to provide improved clearances compared with NIPD within the same or less treatment time. Dialysis flow rate was significantly higher in TPD than NIPD, due to a reduction of dwell time and an increase in the number of exchanges. Peritoneal and total clearances of urea and creatinine were higher, whereas serum creatinine and urea nitrogen levels were lower and treatment duration shorter during TPD than NIPD, notwithstanding a decrease of residual renal function. Moreover, a mean time-averaged blood urea nitrogen level as low as 48.5 +/- 11.6 mg/dl was achieved during TPD. The improvement was more significant in H/HA than in L/LA patients.