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Peritoneal membrane transport function in children receiving long-term dialysis
B A Warady1, S R Alexander, S Hossli
1Children's Mercy Hospital, Kansas City, MO 64108, USA.
Insights
This study standardized peritoneal solute transport testing in 95 pediatric patients undergoing peritoneal dialysis. Results showed similar solute transport ratios across age groups, but mass transfer coefficients varied, suggesting developmental changes in the peritoneal membrane.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Peritoneal Dialysis
Background:
- Accurate characterization of peritoneal solute transport capacity in children is limited by non-standardized testing and small sample sizes.
- Peritoneal dialysis (PD) is a vital renal replacement therapy for pediatric patients.
Purpose of the Study:
- To standardize and evaluate peritoneal solute transport capacity in a large cohort of pediatric patients undergoing chronic peritoneal dialysis.
- To analyze solute transport parameters across different pediatric age groups.
Main Methods:
- A standardized 4-hour peritoneal equilibration test (PET) was administered to 95 pediatric patients (age range: <1 to 19 years).
- Dialysate-to-plasma (D/P) ratios for creatinine and urea, and dialysate glucose (D/D0) were measured.
- Mass transfer area coefficients (MTAC) were calculated for creatinine, urea, glucose, and potassium.
Main Results:
- D/P ratios for creatinine and urea, and D/D0 for glucose were similar across all pediatric age groups and comparable to adult values.
- Normalized MTAC values for glucose and potassium showed significant differences across age groups.
- Quadratic regression revealed a nonlinear decrease with age for MTAC of creatinine, glucose, and potassium.
Conclusions:
- Standardized PET provides reliable solute transport data across the pediatric age spectrum, similar to adults.
- Differences in normalized MTAC values among pediatric age groups suggest maturational changes in the peritoneal membrane or effective surface area.
- These findings contribute to a better understanding of peritoneal membrane function in children undergoing PD.
Abstract:
Accurate characterization of peritoneal solute transport capacity in children has been hampered by a lack of standardized test mechanics and small patient numbers. A standardized peritoneal equilibration test was used to study 95 pediatric patients (mean age, 9.9 +/- 5.6 yr) receiving chronic peritoneal dialysis at 14 centers. Patients were divided into four age groups (< 1, 1 to 3, 4 to 11, 12 to 19 yr) for analysis. Each patient received a 4-h peritoneal equilibration test with an exchange volume of 1100 mL/m2 per body surface area. Dialysate to plasma (D/P) ratios for creatinine (C) and urea (U) and the ratio of dialysate glucose (G) to initial dialysate glucose concentration (D/D0) were determined. Mass transfer area coefficients (MTAC) were calculated for the three solutes and potassium (P). The mean (+/- SD) 4-h D/P ratios for C and U were 0.64 +/- 0.13 and 0.82 +/- 0.09, respectively. The mean 4-h D/D0 for G was 0.33 +/- 0.10. D/P and D/D0 ratio results were similar across age groups. Normalized (for body surface area) mean MTAC (+/- SD) values were as follows: C, 10.66 +/- 3.74; G, 12.93 +/- 5.02; U, 18.43 +/- 4.02; and P, 14.02 +/- 3.94. Whereas a comparison of the normalized MTAC values across age groups with an analysis of variance showed significant age group differences only for glucose (P = 0.001) and potassium (P = 0.036), analysis by quadratic regression demonstrated a nonlinear decrease with age for C (P = 0.016), G (P < 0.001), and P (P = 0.034). In summary, evaluation of D/P and D/D0 ratios obtained from a large group of children in a standardized manner reveals values that are similar across the pediatric age range and not unlike the results obtained in adults. In contrast, normalized MTAC values of young children are greater than the values of older children, possibly as a result of maturational changes in the peritoneal membrane or differences in the effective peritoneal membrane surface area.