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Technical Aspects and Prescription of Peritoneal Dialysis in Children

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Pediatric Dialysis

Abstract

Since 1978, when continuous ambulatory peritoneal dialysis (CAPD) was first introduced for the treatment of pediatric patients with end-stage renal disease (ESRD), a series of technological improvements have been incorporated into the peritoneal dialysis (PD) procedure. Important improvements have been achieved in the safety and ease of use of the mechanical devices employed in the dialysis procedure, as well as in the dialytic efficacy and biocompatibility of the PD solutions. More recently, a revolution in the fields of electronics and computer science has generated a series of automated delivery systems called “cyclers” that allow great prescription flexibility, as well as the monitoring of therapy results and of patient adherence to the dialysis prescription. Unlike CAPD, in which treatment is truly continuous for 24 h of each day, in automated peritoneal dialysis (APD), treatment is usually limited to only a portion of the 24 h, usually overnight. Both CAPD and APD are currently widely used in children around the world.

In this chapter, we describe the most recently developed and currently available equipment for the various forms of PD and provide information on how this equipment can be used to deliver the desired PD therapy for pediatric patients of all ages and sizes. Particular attention is paid to the technical developments that have proven to be most useful in fulfilling the specific clinical needs of the pediatric patient population.

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Notes

  1. 1.

    It should be noted that reliance on membrane transport assessments based on mass transfer of urea or creatinine ignores the difficulty and importance of phosphate clearance. Phosphate PD clearance is usually insufficient to obtain a satisfactory control of hyperphosphatemia, and there is a continued need for dietary restriction and phosphate binder administration. Phosphate removal by PD can be improved by increasing dwell time [89] and by optimizing exchange duration through the calculation of the so-called phosphate purification dwell time (PPT) from a PET [66].

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Authors and Affiliations

  1. Dialysis Unit, IRCCS Istituto Giannina Gaslini, Department of Pediatrics, Genoa, Italy

    Enrico Eugenio Verrina

  2. University of Iowa Stead Family Children’s Hospital, Pediatric Nephrology, Dialysis, and Transplantation, Iowa City, IA, USA

    Lyndsay A. Harshman

Authors
  1. Enrico Eugenio Verrina
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  2. Lyndsay A. Harshman
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Correspondence to Enrico Eugenio Verrina .

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Editors and Affiliations

  1. Department of Pediatrics, University of Missouri-Kansas City, School of Medicine, Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

  2. Stanford University School of Medicine, Division of Pediatric Nephrology, Department of Pediatrics, Palo Alto, CA, USA

    Steven R. Alexander

  3. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany

    Franz Schaefer

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Verrina, E.E., Harshman, L.A. (2021). Technical Aspects and Prescription of Peritoneal Dialysis in Children. In: Warady, B.A., Alexander, S.R., Schaefer, F. (eds) Pediatric Dialysis. Springer, Cham. https://doi.org/10.1007/978-3-030-66861-7_13

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