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Influence of age, time, and peritonitis on peritoneal transport kinetics in children
T M Hölttä1, K A Rönnholm, C Holmberg
1Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Finland.
Insights
Peritoneal transport kinetics in children undergoing dialysis are age-independent when adjusted for body surface area. Peritoneal membrane function remains stable over time, showing consistent solute transfer rates (MTAC) in pediatric patients.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
- Peritoneal Dialysis
Background:
- Peritoneal dialysis is a vital renal replacement therapy for children.
- Understanding peritoneal transport kinetics is crucial for optimizing treatment.
- Age-related differences in peritoneal function in pediatric patients require investigation.
Purpose of the Study:
- To evaluate peritoneal transport kinetics in children with and without peritonitis.
- To assess changes in peritoneal transport over time.
- To determine age-specific differences in peritoneal function, comparing children under and over 5 years old.
Main Methods:
- A prospective study involving 28 pediatric patients on maintenance peritoneal dialysis.
- A 4-hour peritoneal equilibration test (PET) using 2.27% dextrose with a dialysate fill volume adjusted to body surface area (BSA).
- Measurement of peritoneal equilibration rates and calculation of mass transfer area coefficients (MTAC) for key solutes at baseline and after a mean of 0.8 years.
Main Results:
- Dialysate-to-plasma (D/P) ratios for urea, creatinine, and albumin, and D/D0 for glucose were similar between age groups (<5 vs. >5 years).
- Peritoneal membrane function remained stable over the study period, with no significant changes in D/P or D/D0 ratios.
- Mass transfer area coefficients (MTAC) for urea, creatinine, glucose, and albumin were age-independent and showed no significant changes over time.
Conclusions:
- Peritoneal transport kinetics, assessed by solute D/P ratios, are independent of age in pediatric patients when dialysis volume is proportional to BSA.
- Mass transfer area coefficients (MTAC) in pediatric patients are also age-independent.
- Peritoneal membrane function is stable in children undergoing continuous peritoneal dialysis.
Objective:
To evaluate peritoneal transport kinetics and its changes over time in children with and without peritonitis, and to record possible differences between children under and over 5.0 years of age.
Design:
A prospective study. The patients underwent a 4-hour peritoneal equilibration test (PET) comprising 2.27% dextrose with a dialysate fill volume of 1000 mL/m2 of body surface area (BSA), at baseline and after a mean of 0.8 +/- 0.4 years of uninterrupted dialysis.
Patients:
We investigated 28 patients on maintenance peritoneal dialysis at baseline; 10 were under 5.0 years of age. The final PET was performed in 21 patients.
Main Outcome Measures:
Peritoneal equilibration rates for urea (U), creatinine (C), glucose (G), sodium, potassium, phosphate, and albumin (A) were measured. Initial and final peritoneal equilibration rates were compared. Mass transfer area coefficients (MTAC) were calculated for urea, creatinine, glucose, and albumin. Residual dialysate volume was determined.
Results:
Median age at first PET was 7.6 years (range 0.3-16.6 yr). The mean (+/- 1 SD) 4-hour dialysate-to-plasma (D/P) ratios for U, C, and A were 0.92 +/- 0.05, 0.70 +/- 0.12, and 0.014 +/- 0.007, respectively. The mean 4-hour D/D0 ratio for G was 0.32 +/- 0.10. D/P and D/D0 results were similar in the two age groups, and peritoneal membrane function remained stable over the study period. Mean MTAC (+/- 1 SD) values were: U, 22.3 +/- 4.8; C, 10.9 +/- 4.1; G, 11.1 +/- 3.3; and A, 0.07 +/- 0.03. MTAC data were similar in the two age groups and no significant changes occurred during the study period.
Conclusions:
When the volume tested in children is proportional to BSA, the solute D/P ratios seem to be age-independent. Our data provide evidence that in pediatric patients MTAC is also age-independent.