Selection of modalities, prescription, and technical issues in children on peritoneal dialysis

Enrico Verrina, Valeria Cappelli, Francesco Perfumo

Research output: Contribution to journalArticle

Abstract

Peritoneal dialysis (PD) is widely employed as a dialytic therapy for uraemic children, especially in its automated form (APD), that is associated with less burden of care on patient and family than continuous ambulatory PD. Since APD offers a wide range of treatment options, based on intermittent and continuous regimens, prescription can be individualized according to patient's age, body size, residual renal function, nutritional intake, and growth-related metabolic needs. Transport capacity of the peritoneal membrane of each individual patient should be assessed, and regularly monitored, by means of standardized peritoneal function tests validated in pediatric patients. To ensure maximum recruitment of peritoneal exchange area, fill volume should be scaled to body surface area and adapted to each patient, according to clinical tolerance and intraperitoneal pressure. PD solutions should be employed according to their biocompatibility and potential ultrafiltration capacity; new pH-neutral, glucose-free solutions can be used in an integrated way in separate dwells, or by appropriately mixing during the same dialytic session. Kinetic modelling software programs may help in the tailoring of PD prescription to individual patients' characteristics and needs. Owing to advances in the technology of new APD machines, greater programming flexibility, memorized delivery control, and tele-dialysis are currently possible.

Original languageEnglish
Pages (from-to)1453-1464
Number of pages12
JournalPediatric Nephrology
Volume24
Issue number8
DOIs
Publication statusPublished - 2009

Keywords

  • Automated peritoneal dialysis
  • Children
  • Peritoneal dialysis
  • Peritoneal dialysis prescription
  • Peritoneal dialysis solutions
  • Peritoneal membrane function

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

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