RESUMEN
The known relationship between peritoneal fill volume (IVP) and dialysis efficiency favors the use of an optimal IVP to enhance peritoneal dialysis (PD). Therefore, we have studied the effects of an increased IVP in consecutive stages [800, 1400, and 2000 mL/m2 of body surface area (BSA), respectively] in 8 children on chronic PD (mean age: 9 years 6 months; range: 2-16 years). Each prescribed IVP was maintained for 60 minutes of dwell time, allowing a short peritoneal equilibration test. Tolerance was assessed clinically and by intraperitoneal pressure (IPP) measurements at the end of each dwell test. Determination of dialysate-to-plasma ratios, and calculation of mass transfer area coefficients (K0A) using the Henderson method for urea, creatinine, and phosphate, were used to assess the impact of an increased IVP on dialytic efficiency. Increasing IVP from 800 to 1400 and thereafter to 2000 mL/m2 induced an IPP increment, respectively, from 8.4 +/- 1.4 cm (of water) to 12.1 +/- 1.4 cm and thereafter to 18.3 +/- 1.4 cm, with a positive strong linear correlation (r = 0.92; P = 0.001; IPP = 1.46 +/- 8.17(-3) IVP). In the same manner increasing IVP induced K0A increments for urea of 10.6 +/- 1.2 mL/min per m2 to 15.3 +/- 1.6 mL/min per m2 and 17.1 +/- 1.9 mL/min per m2; for creatinine of 7.9 +/- 0.09 mL/min per m2 to 11.2 +/- 0.18 mL/min per m2, and 12.3 +/- 0.21 mL/min per m2; and for phosphate of 5.2 +/- 0.08 mL/min per m2 to 6.7 +/- 0.09 mL/min per m2 and 6.6 +/- 0.07 mL/min per m2, respectively. When K0A values were normalized to the values achieved at the IVP of 1400 mL/m2, the K0A gain obtained increasing IVP from 1400 to 2000 mL/m2 was only significant for urea, peaked for creatinine, and even slowly decreased for phosphate. Moreover, a fill volume over 1400 mL/m2, which appears to be the optimal volume in terms of dialysis efficiency, was only barely tolerated with clinical signs of discomfort and an increased IPP. Therefore, in our opinion, the maximal IVP in children over the age of 2 years should be nearly 1400 mL/m2, both in terms of abdominal tolerance and in terms of urea, creatinine, and phosphate peritoneal membrane purification capacities.
Asunto(s)
Diálisis Peritoneal/métodos , Adolescente , Niño , Preescolar , Creatinina/metabolismo , Humanos , Fosfatos/metabolismo , Proteínas/metabolismo , Urea/metabolismoRESUMEN
Dialysed infants are sometimes characterized by a hyperpermeable peritoneal state. In this situation decreasing dwell time and/or increasing dialysate tonicity are usually proposed to achieve adequate ultrafiltration (UF). We have investigated UF capacity under different peritoneal dialysis modalities in three infants. UF was not obtained with isotonic continuous ambulatory peritoneal dialysis (CAPD), and was only achieved with short dwell times and hypertonic CAPD. For the prescription of automated peritoneal dialysis, a shorter dwell time of hourly sequences is needed, which consequently decreases the phosphate diffusion time. Continuous cycling peritoneal dialysis with sequences of 1 h allowed efficient UF [UF/glucose absorption (UF/G) 4.2 +/- 0.9] but the dialysate/plasma (D/P) phosphate ratio was low (0.47 +/- 0.12). In contrast, tidal peritoneal dialysis gave a better UF/G ratio (6.8 +/- 0.7) without a decrease in the D/P phosphate ratio (0.64 +/- 0.18).
Asunto(s)
Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Líquidos Corporales/metabolismo , Soluciones para Diálisis , Edema/metabolismo , Humanos , Hipertensión/metabolismo , Lactante , Fallo Renal Crónico/metabolismo , UltrafiltraciónRESUMEN
Continuous cycling peritoneal dialysis (CCPD) is automatically performed by a cycler as a repetition several times per session of the same programmed exchange. We have investigated the efficiency, in terms of ultrafiltration (UF) capacity and solute clearance (phosphate), of an adapted (optimized) CCPD versus a conventional CCPD. Adapted CCPD was performed manually in order to allow a combination of short dwell times (optimal ultrafiltration) and long dwell times (optimal purification). The ratio of ultrafiltration over glucose absorbed (UF/G) was higher with adapted CCPD (5.7 +/- 0.8) compared with conventional CCPD (4.8 +/- 1.3). Phosphate purification was also enhanced with adapted CCPD (0.21 +/- 0.05 versus 0.16 +/- 0.05 mL/min/kg). These results confirm the usefulness of the concept of adapted CCPD with variable dwell times for optimization of peritoneal dialysis performances in children.
Asunto(s)
Diálisis Peritoneal , Peritoneo/metabolismo , Absorción , Glucosa/metabolismo , Humanos , Lactante , Diálisis Peritoneal/métodos , Prescripciones , UltrafiltraciónRESUMEN
Intraperitoneal pressure (IPP) is easy to measure routinely in children on peritoneal dialysis (PD) (especially with the twin bag Y-set) as described in adults: value expressed in centimeters of water, average of IPP (mean IPP) at inspiration and at expiration, with point zero located on the mid-axillary line while the patient rests in a perfectly supine position. IPP remained high during the first two to three days postsurgical peritoneal catheter implantation (15 +/- 4 cm) despite low dialysate volume per exchange (10 mL/kg). Afterwards, IPP decreased (10 +/- 2 cm) despite increasing dialysate volume from 10-50 mL/kg. Mean IPP seemed lower in infants (5 +/- 3 cm) in contrast to children (10 +/- 2 cm) on chronic PD with dialysate volume of 1000 mL/m2. There was a strong negative linear correlation between ultrafiltration (UF) volume and mean IPP with isotonic dialysate (1.36% dextrose concentration). By contrast, there was only a weak positive linear correlation between UF volume and mean IPP with hypertonic dialysate (3.86% dextrose concentration).