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[Peritoneal dialysis in children]
1Service de pédiatrie I, hôpital de Hautepierre, Strasbourg, France.
Insights
Continuous peritoneal dialysis (PD) is now a widely used home treatment for children, even infants. Objective methods improve PD prescription, but ongoing support is crucial for families undergoing home dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Home Healthcare
Context:
- Continuous peritoneal dialysis (PD) has seen significant advancements and increased application in pediatric patients.
- The technique is adaptable for home care settings, including for infants.
- Historically, PD prescription was empirical, but has evolved with objective assessment methods.
Purpose:
- To describe the evolution and current state of continuous peritoneal dialysis in children.
- To highlight objective approaches for optimizing PD prescription, including dwell volume, pressure monitoring, and dialysis adequacy.
- To underscore the challenges and support systems required for pediatric home dialysis.
Summary:
- Modern peritoneal dialysis (PD) prescription for children utilizes objective measures like intraperitoneal pressure for tolerance and APEX time for dialysis adequacy (ultrafiltration, purification).
- This approach has refined the empirical methods previously used, improving treatment efficacy.
- The focus is on optimizing dwell volume and dwell time for better outcomes in pediatric PD.
Impact:
- Improved management and outcomes for children requiring dialysis, enabling home-based care.
- Enhanced understanding of objective parameters for tailoring PD therapy to pediatric needs.
- Highlights the critical need for comprehensive family and medical team support in pediatric home dialysis programs.
Abstract:
In the recent years, continuous peritoneal dialysis (PD) had a widespread development in children. This technique is available even in infants and is adapted to home care. If initially the prescription of PD was empirical, it has nowadays improved thanks to objective approaches: intraperitoneal dwell volume and tolerance assessment by intraperitoneal pressure measurement, dwell time determination in terms of dialysis adequacy, ie APEX time as ultrafiltration and low molecular purification times. Nevertheless children home dialysis is a daily challenge for the family and requires an active and long-lasting support from the medical and paramedical team.