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Peritoneal equilibration test curves and adequacy of dialysis in children on automated peritoneal dialysis
G A Sliman1, K M Klee, B Gall-Holden
1Department of Pediatrics, University of Washington, Seattle.
Insights
Pediatric patients on automated peritoneal dialysis exhibit higher solute transport rates than adults, indicating faster diffusion. This suggests potential differences in dialysis prescription needs for children compared to established adult guidelines.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Dialysis
Background:
- Peritoneal equilibration tests (PETs) are crucial for guiding dialysis prescriptions in adult continuous ambulatory peritoneal dialysis (CAPD) patients.
- Limited studies exist on PETs and adequacy in pediatric patients using nightly cycling peritoneal dialysis.
Purpose of the Study:
- To evaluate peritoneal equilibration tests (PETs) and dialysis adequacy in pediatric patients undergoing automated peritoneal dialysis (APD).
- To compare solute transport rates in children with published adult data to inform pediatric APD prescription.
Main Methods:
- Conducted 49 PETs in 28 pediatric APD patients (mean age 8.9 years) using Dianeal 2.5% dialysate.
- Analyzed 24-hour dialysate collections for protein loss, glucose absorption, and weekly Kt/V.
- Calculated mean dialytic creatinine clearance from 4-hour dwell.
Main Results:
- 80% of pediatric PETs indicated high average/high solute transport, exceeding adult norms.
- Mean weekly Kt/V was 1.94 +/- 0.94; mean creatinine clearance was 5.6 mL/min/1.73 m2.
- Children showed significantly higher solute diffusion rates (creatinine and glucose) compared to adults (P < 0.0013).
Conclusions:
- Pediatric patients on APD demonstrate higher solute diffusion rates than adults.
- Younger children may exhibit more rapid solute transport than older children.
- Findings suggest potential need for adjusted dialysis prescriptions in pediatric APD.
Abstract:
Peritoneal equilibration tests (PETs) and adequacy studies have been performed to guide dialysis prescriptions in adult continuous ambulatory peritoneal dialysis patients, although few studies have been reported in pediatric patients on nightly cycling peritoneal dialysis. We performed 49 PETs in 28 children on automated peritoneal dialysis (mean age, 8.9 years; age range, 0.2 to 19.8 years; mean time on dialysis, 14.1 months) using Dianeal 2.5% dialysate (Baxter Healthcare Corp, McGaw Park, IL) inflow volumes of 1,200 mL/m2 (approximately 40 mL/kg), and standard technique. Mean 4-hour dialysate/plasma creatinine was 0.73 +/- 0.12 (range, 0.45 to 1.03). Mean 4-hour dialysate glucose/initial dialysate glucose was 0.28 +/- 0.10 (range, 0.06 to 0.50). Eighty percent of these PETs fell into the high average/high solute transport categories proposed by Twardowski, based on adult PETs. Twenty-four-hour dialysate collections were analyzed in 28 patients for protein loss and glucose absorption, as well as for calculation of weekly Kt/V. Mean weekly Kt/V was 1.94 +/- 0.94 (range, 0.63 to 5.10). Mean dialytic creatinine clearance calculated from the 4-hour dwell was 5.6 +/- 1.0 mL/min/1.73 m2 (56 L/wk/1.73 m2). Mean daily protein loss was 0.20 +/- 0.13 g/kg/d (range, 0.2 to 9.1 g/d) and glucose absorption was 3.49 +/- 2.24 g/kg/d (range, 17 to 196 g/d). Our results show higher solute diffusion rates in children compared with the published adult PET results (P = 0.0013 and P < 0.0001 for 4-hour creatinine and glucose results, respectively), with trends toward more rapid solute transport in younger compared with older children.(ABSTRACT TRUNCATED AT 250 WORDS)