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Hydrostatic intraperitoneal pressure in children on peritoneal dialysis: practical implications. An 18-month clinical
M Fischbach1, P Desprez, F Donnars
1Nephrology Dialysis Transplantation Children's Unit, Strasbourg, France.
Insights
Intraperitoneal pressure (IPP) in children undergoing peritoneal dialysis (PD) is measurable and decreases post-surgery. Ultrafiltration volume significantly impacts IPP, especially with isotonic dialysate.
Area of Science:
- Pediatric Nephrology
- Medical Engineering
- Clinical Measurement
Background:
- Routine measurement of intraperitoneal pressure (IPP) is feasible in pediatric peritoneal dialysis (PD) patients.
- IPP measurement methods used in adults can be applied to children, particularly with twin bag Y-set systems.
Purpose of the Study:
- To assess the feasibility and trends of intraperitoneal pressure (IPP) measurements in children undergoing peritoneal dialysis (PD).
- To investigate the relationship between IPP, dialysate volume, patient age, and ultrafiltration (UF) in pediatric PD patients.
Main Methods:
- IPP was measured in centimeters of water, averaging values during inspiration and expiration.
- Measurements were taken with the zero point on the mid-axillary line in a supine position.
- IPP was recorded post-surgical catheter implantation and during chronic PD with varying dialysate volumes and concentrations.
Main Results:
- IPP was elevated (15 +/- 4 cm H2O) in the initial days post-surgery, even with low dialysate volumes (10 mL/kg).
- IPP decreased (10 +/- 2 cm H2O) over time despite increased dialysate volumes (10-50 mL/kg).
- Mean IPP was lower in infants (5 +/- 3 cm H2O) compared to children (10 +/- 2 cm H2O) on chronic PD.
- A strong negative linear correlation existed between UF volume and mean IPP with isotonic dialysate (1.36% dextrose).
- A weak positive linear correlation was observed between UF volume and mean IPP with hypertonic dialysate (3.86% dextrose).
Conclusions:
- Intraperitoneal pressure (IPP) measurement is a practical routine in pediatric peritoneal dialysis (PD).
- IPP decreases post-surgery and with increasing dialysate volumes, with variations noted between infants and children.
- Ultrafiltration volume has a significant, concentration-dependent impact on IPP in pediatric PD patients.
Abstract:
Intraperitoneal pressure (IPP) is easy to measure routinely in children on peritoneal dialysis (PD) (especially with the twin bag Y-set) as described in adults: value expressed in centimeters of water, average of IPP (mean IPP) at inspiration and at expiration, with point zero located on the mid-axillary line while the patient rests in a perfectly supine position. IPP remained high during the first two to three days postsurgical peritoneal catheter implantation (15 +/- 4 cm) despite low dialysate volume per exchange (10 mL/kg). Afterwards, IPP decreased (10 +/- 2 cm) despite increasing dialysate volume from 10-50 mL/kg. Mean IPP seemed lower in infants (5 +/- 3 cm) in contrast to children (10 +/- 2 cm) on chronic PD with dialysate volume of 1000 mL/m2. There was a strong negative linear correlation between ultrafiltration (UF) volume and mean IPP with isotonic dialysate (1.36% dextrose concentration). By contrast, there was only a weak positive linear correlation between UF volume and mean IPP with hypertonic dialysate (3.86% dextrose concentration).