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The peritoneal equilibration test in children
J D Hanna1, J W Foreman, T W Gehr
1Department of Pediatrics, Children's Medical Center, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0498.
Insights
Children and adults show similar glucose absorption during peritoneal dialysis, but children have different creatinine clearance and drain volumes when adjusted for body surface area versus body weight. This highlights age-related differences in peritoneal dialysis efficiency.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis are common renal replacement therapies.
- Understanding age-specific differences in peritoneal dialysis (PD) is crucial for optimizing treatment protocols.
Purpose of the Study:
- To compare the peritoneal equilibration test (PET) parameters between pediatric and adult patients undergoing CAPD/continuous cycling peritoneal dialysis.
- To investigate age-related variations in peritoneal transport and fluid dynamics.
Main Methods:
- A standardized peritoneal equilibration test (PET) protocol was applied to 8 children and 9 adults on CAPD/continuous cycling peritoneal dialysis.
- Key parameters assessed included glucose and creatinine transport, dialysate/plasma (D/P) ratios, drain volume, and ultrafiltration.
Main Results:
- Children exhibited faster glucose equilibration but similar glucose absorption percentages compared to adults.
- Peritoneal creatinine clearance and drain volume, when scaled to body surface area, were lower in children but normalized when adjusted for body weight.
- Children had higher initial D/P creatinine ratios, which converged with adult values over time.
Conclusions:
- While glucose absorption is comparable, age influences peritoneal creatinine transport and fluid removal dynamics when normalized to body surface area.
- Weight normalization reveals similar peritoneal transport characteristics between children and adults, suggesting body composition is a key factor.
- These findings underscore the importance of individualized PD prescription based on patient-specific factors like age and body weight.
Abstract:
Eight children, aged 15 months to 17 years 9 months, maintained by continuous ambulatory peritoneal dialysis (CAPD)/continuous cycling peritoneal dialysis and nine adults, aged 20-59 years, managed by CAPD were compared using a standardized peritoneal dialysis protocol, the peritoneal equilibration test (PET). The peritoneal glucose concentration tended to equilibrate with the serum glucose more rapidly in children, but the percentage of the glucose load absorbed was not different between the two age groups. There was an inverse trend between the percentage of glucose absorbed and age in children. Peritoneal creatinine clearance scaled to surface area in children was significantly less than that of the adults; however, the clearances became similar when adjusted for body weight. Peritoneal creatinine clearance scaled to surface area bore a positive and significant relationship to age which, when expressed per kilogram body weight, disappeared. Children had a significantly higher dialysate/plasma (D/P) creatinine ratio after the first 2 h of the PET, but this ratio approached unity by 4 h and was not different from adults. The fractional change in the creatinine D/P ratio during the PET was not different between the two age groups. Drain volume adjusted to surface area was significantly less in children than adults. This difference was reversed when drain volume was factored by weight. Similarly drain volume scaled to surface area demonstrated a significant and positive relationship to age, which disappeared when drain volume was expressed per kilogram body weight. Ultrafiltration, whether factored by weight or scaled to surface area, did not differ between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)