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Improved dialysis dose by optimizing intraperitoneal volume prescription thanks to intraperitoneal pressure
M Fischbach1, J Terzic, C Dangelser
1Nephrology Dialysis Transplantation Children's Unit, Strasbourg, France.
Insights
Optimizing intraperitoneal volume (Vip) in children undergoing continuous cyclic peritoneal dialysis significantly enhances solute clearance. Using the highest tolerated Vip, especially during supine sleep, improves dialysis efficiency without adverse effects.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Technology
Background:
- Intraperitoneal volume (Vip) is a critical yet underutilized parameter in peritoneal dialysis.
- Higher Vip can improve small solute clearance more effectively than increased exchange frequency.
- Supine positioning minimizes intraperitoneal pressure (Pip), allowing for higher Vip.
Purpose of the Study:
- To evaluate the impact of optimizing intraperitoneal volume (Vip) on dialysis efficiency and tolerance in pediatric patients.
- To determine if increasing Vip improves solute clearance and dialysis dose in children on CCPD.
- To assess the safety and efficacy of higher Vip in the supine position.
Main Methods:
- A study involving 5 children on continuous cyclic peritoneal dialysis (CCPD).
- Intraperitoneal volume (Vip) was incrementally increased, monitoring intraperitoneal pressure (Pip).
- Dialysis efficiency was assessed by daily Kt/Vurea and weekly creatinine clearance (Kcreatinine) over a 4-week period.
Main Results:
- Optimized Vip (1230 mL/m2) was significantly higher than basal Vip (940 mL/m2).
- Daily Kt/Vurea increased from 0.23 to 0.29, and weekly Kcreatinine improved from 60 to 76 L/1.73 m2/week.
- A 25% increase in Pip was tolerated in the supine position without adverse effects.
Conclusions:
- Optimizing intraperitoneal volume is a highly effective strategy to enhance small solute clearance in pediatric CCPD.
- The highest tolerated Vip, particularly during nocturnal supine positioning, should be utilized for improved dialysis outcomes.
- Increasing Vip is a safe and efficient method to augment dialysis dose in children.
Abstract:
An optimal intraperitoneal volume (Vip) may be the most critical and least-used option to enhance higher clearances of small solutes. A higher Vip is more effective in increasing small solute clearances when compated to a lower Vip and more frequent exchanges. Additionally, a higher Vip generates minimal intraperitoneal pressure (Pip) in the supine position. Therefore, the highest tolerated Vip should be used at night while the child is sleeping in the supine position. Therefore, in 5 children, mean age 7 years, 4 months, on continuous cyclic peritoneal dialysis (CCPD) (Baxter HomeChoice), we tested the impact of Vip on tolerance (measured by Pip) measurements, and efficiency [assessed by daily Kt/Vurea and weekly creatinine clearance (Kcreatinine]. Basal Pip was determined for the usually prescribed Vip. Then Vip was increased during a morning outpatient study day, in 30-minute stages, stepping up to an increase of 25% of the basal Pip (upper limit 18 cm of water) level reached at the so-called optimized Vip used for the prescription of an optimal total dialysate volume for a 4-week period. The latest study week was compared to the prestudy week. The optimized Vip of 1230 +/- 70 mL/m2 was significantly higher than the basal Vip, 940 +/- 90 mL/m2. The dialysis dose improved both in terms of Kt/V urea from 0.23 +/- 0.02 to 0.29 +/- 0.03 and Kcreatinine from 60 +/- 5 to 76 +/- 9 L/1.73 m2/week. The supine position allowed the 25% Pip increment from 10.2 +/- 2.5 to 12.5 +/- 3.1 cm water, without any obvious clinical side effects.