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Adequate dialysis? Measurement of KT/V in a pediatric peritoneal dialysis population
T L Walk1, C H Schröder, R E Reddingius
1Department of Pediatrics, University of Nijmegen, The Netherlands.
Insights
Pediatric peritoneal dialysis (PD) patients achieved high urea and creatinine clearance, with residual renal function significantly contributing to outcomes. Target KT/V levels require further definition due to multifactorial adequacy criteria.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Kinetics
Background:
- Understanding urea and creatinine kinetics is crucial for optimizing dialysis therapy in children.
- Pediatric populations present unique challenges in assessing dialysis adequacy compared to adults.
Purpose of the Study:
- To quantify urea and creatinine kinetics in pediatric patients undergoing peritoneal dialysis (PD).
- To compare dialysis adequacy between continuous ambulatory PD (CAPD) and nocturnal intermittent PD (NIPD) in children.
Main Methods:
- Measured KT/V and creatinine clearance (Ccr) in 19 pediatric PD patients.
- Included 13 CAPD and 6 NIPD patients.
- Analyzed correlations with residual renal function, age, blood urea, serum albumin, and protein intake.
Main Results:
- Mean weekly KT/V was 2.31 ± 0.78; mean Ccr was 74 ± 47 L/week/1.73 m².
- No significant difference in dialytic KT/V between CAPD and NIPD groups.
- Strong correlation (r=0.9) between KT/V urea and Ccr, linked to residual renal function.
Conclusions:
- Pediatric PD patients exhibited higher mean KT/V than reported adult values.
- Residual renal function plays a substantial role in achieving high KT/V in this cohort.
- Defining optimal KT/V targets remains complex due to multifactorial dialysis adequacy criteria.
Objective:
To measure the urea and creatinine kinetics in a pediatric population.
Patients And Methods:
In 19 children treated with peritoneal dialysis (PD) KT/V, urea and creatinine clearances (Ccr) were measured. Thirteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 6 on highly intermittent peritoneal dialysis (NIPD).
Results:
Mean KT/V per week was 2.31 +/- 0.78 and mean creatinine clearance 74 +/- 47 L/week/1.73 m2. There was no difference in dialytic KT/V between patients treated with CAPD and NIPD (1.75 +/- 0.21 vs 1.76 +/- 0.50). The correlation between KT/V urea and creatinine clearance was 0.9 (p < 0.001). There was a clear relationship of these parameters with residual renal function, but not with age or blood urea level. A weak positive correlation was found with serum albumin and protein intake.
Conclusions:
Mean KT/V in this patient group was higher than the values reported for most adult patient groups. Residual renal function considerably contributes to this high KT/V. It is not clearly defined which KT/V should be aimed for, since criteria for adequate dialysis are multifactorially determined and therefore difficult to interpret.
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