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Measurement of peritoneal fluid handling in children on continuous ambulatory peritoneal dialysis using autologous
R E Reddingius1, C H Schröder, H L Willems
1Department of Paediatrics, Sint Radboud University Hospital, Nijmegen, The Netherlands.
Insights
Children undergoing continuous ambulatory peritoneal dialysis (CAPD) exhibit higher marker clearance (MC) than adults. This suggests potential challenges in achieving adequate ultrafiltration (UF) in pediatric CAPD patients.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Dialysis Techniques
Background:
- Previous studies on peritoneal fluid handling in pediatric continuous ambulatory peritoneal dialysis (CAPD) used human albumin, which has limitations due to endogenous albumin presence.
- Autologous hemoglobin was employed as a more accurate volume marker to overcome these limitations.
Purpose of the Study:
- To measure peritoneal fluid kinetics in children on CAPD using autologous hemoglobin as a volume marker.
- To compare marker clearance (MC) and transcapillary ultrafiltration (TCUF) in pediatric CAPD patients.
Main Methods:
- Nine children on CAPD (median age 8.1 years) participated.
- Autologous hemoglobin was added to 1.36% glucose dialysate.
- Marker clearance (MC) and transcapillary ultrafiltration (TCUF) were measured over a 4-hour dwell period.
Main Results:
- Marker clearance (MC) was significantly higher in children (521 mL/4 hr/1.73 m²) compared to adult CAPD literature data.
- Transcapillary ultrafiltration (TCUF) was similar to adult data (519 mL/4 hr/1.73 m²) and did not reach a maximum within 4 hours.
- The TCUF curve deviation from linearity was less pronounced than typically observed in adults.
Conclusions:
- Pediatric CAPD patients demonstrate higher marker clearance than adults.
- Potential difficulties in achieving sufficient ultrafiltration in children may stem from smaller differences between MC and TCUF during the dwell period.
Objective:
Previous measurements of peritoneal fluid handling in children treated by continuous ambulatory peritoneal dialysis (CAPD) were performed with human albumin as a fluid marker. A major disadvantage of this substance is that endogenous patient albumin enters the peritoneal cavity during the dwell period. For this reason peritoneal fluid kinetics were measured in a group of children on CAPD, using autologous hemoglobin as a volume marker.
Design:
Autologous hemoglobin was added to dialysate containing 1.36% glucose as a volume marker. Marker clearance (MC), which is presently the best available approximation of lymphatic absorption in the clinical setting, and transcapillary ultrafiltration (TCUF) were measured during a 4-hour dwell.
Setting:
University hospital.
Patients:
Children on CAPD (N = 9), with a median age of 8.1 years (range 2.1-3.2 years).
Results:
MC was 521 +/- 166 mL/4 hour/1.73 m2, which is high compared to the literature data on adult CAPD patients. TCUF was 519 +/- 92 mL/4 hour/1.73 m2, which is similar to data concerning adult patients. TCUF reached no maximum during the 4-hour dwell, and the deviation of the TCUF curve from linear was markedly less than usually seen in adult patients.
Conclusions:
MC in children treated with CAPD is higher when compared to the literature data on adults. Difficulties to achieve sufficient ultrafiltration in children could be caused by relatively small differences between MC and TCUF from the beginning to the end of the dwell.