Are current peritoneal dialysis solutions adequate for pediatric use

Enrico Eugenio Verrina, Rossella Cannav̀, Betti Schaefer, Claus Peter Schmitt

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Peritoneal dialysis (PD) is the treatment modality of choice in pediatric CKD5D patients awaiting renal transplantation. Facing many decades of renal replacement therapy long term preservation of peritoneal membrane function is of particular importance in this patient group. Whereas conventional PD fluids induce severe morphological and functional alterations of the peritoneal membrane within a few years, reduction of glucose degradation product content by multichamber systems, replacement of glucose by icodextrin and amino acids, and of lactate by bicarbonate at a neutral to physiological pH are expected to preserve peritoneal membrane integrity. Based on numerous in vitro, experimental and clinical studies, the European Pediatric Dialysis Working Group recommended the use of low glucose degradation product solutions whenever possible. Icodextrin is considered a useful option, in particular in children with sodium and water overload, even though infants may absorb higher amounts of icodextrin and achieve less ultrafiltration. The concept of amino acid- based PD fluids is intriguing, but pediatric benefits are insufficiently described and cannot replace tube feeding in malnourished children. Bicarbonatebased PD fluids better control metabolic acidosis and have been recommended in children with acute kidney injury and impaired lactate metabolism. This review discusses the scientific evidence and potential advantages of PD solutions with an improved biocompatibility profile, with a particular focus on pediatric studies.

Original languageEnglish
Title of host publicationContributions to Nephrology
Pages16-22
Number of pages7
Volume178
Publication statusPublished - 2012

Publication series

NameContributions to Nephrology
Volume178
ISSN (Print)03025144

ASJC Scopus subject areas

  • Nephrology

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    Verrina, E. E., Cannav̀, R., Schaefer, B., & Schmitt, C. P. (2012). Are current peritoneal dialysis solutions adequate for pediatric use. In Contributions to Nephrology (Vol. 178, pp. 16-22). (Contributions to Nephrology; Vol. 178).