Objectives To establish intraperitoneal pressure (IPP) in a relatively large pediatric study group and to study the effects of a 3.86% glucose solution and a 7.5% icodextrin solution on IPP during a 4-hour dwell. Design IPP was measured with the patient in a supine position. The intraperitoneal volume (IPV) was 1200 mL/m2 with a 1.36% glucose solution. The influence of dialysis solutions was obtained by performing two 4-hour peritoneal equilibration tests (PETs) with 3.86% glucose and 7.5% icodextrin as test solution, using an IPV of 1200 mL/m2 and dextran 70 as volume marker. IPP was measured at two consecutive time points ( t = 0 and t = 240 minutes). Transcapillary ultrafiltration, net ultrafiltration, and marker clearance were calculated. Patients IPP was established in 30 patients with median age of 4.5 years (range 1.0 – 14.9 years). Influence of dialysis solutions on IPP was studied in 9 children with median age of 4.2 years (range 1.7 – 10.9 years) and median treatment period of 12 months (range 5.6 – 122.3 months). Results Mean IPP was 12.0 ± 6.5 cm H2O. Significant relations were found between the change in IPP and transcapillary ultrafiltration and body surface area during the PET with 3.86% glucose. No relations were seen during the PET with icodextrin. Conclusions IPP was established in a large pediatric study group and was similar to previously published values of IPP in a small number of patients. Differences in fluid kinetics have different effects on the change in IPP during a 4-hour dwell period.

The increase in PLA2 activity with bacterial infec tion of th e peritoneal cavity is not unexpected; stud ies have documented an increase in PLA2 in chronic inflammatory states, acute bacterial infections, and system ic sepsis. Patients with bacteremia, sepsis syndrome, and malaria have high plasma PLA2 ac tivity which correlates with the hemodynamic changes and pulmonary dysfunction (9,10). Furthermore, the local and systemic manifestations of inflammation can be induced by the administration of exogenous purified PLA2.The clinical importance of these observations re mains unknown. There is significant evidence that the presence of phosphatidylcholine plays a role in facilitat ing peritoneal ultrafiltration (11,12). Degradation of phosphatidylcholine would thus be associated with impaired ultrafiltration. Phospholipase A2 catalyzes the hydrolysis of phosphatidylcholine to lyso-phosphatidylcholine. We speculate that high intraperitoneal PLA2 activity in renal failure, especially during perito nitis, hydrolyzes phosphatidylcholine and contributes to the decreased peritoneal ultrafiltration. This action may be at least partially responsible for the ultrafil tration failure during peritonitis. Furthermore, lysophosphatidylclioline is a vasoactive substance and may be contributory to intraperitoneal vasodilatation, part of the local inflammatory reaction. REFERENCES 1. Kramer RM, Hession C, Johansen B, et aL Structure and properties of a human non-pancreatic phospho lipase A2. J Biol Chem 1989; 264:5768-75. 2. Pruzanski W, Vadas P. Soluble phospholipase A2 in human pathology: clinical-laboratory interface. Adv Exp Med Biol 1990; 275:83-101, 3. Peuravuori HJ, Funatomi H, Nevalainen TJ. Group I and group II phospholipase s A2 in serum in uraemia. Eur J Clin Chem ClinBiochem 1993; 31:491-4. 4. Morton AR, Vadas P, Stefanski E, Pruzanski W, Pierratos A. Increased levels of phospholipase A2 in renal failure patients. The American Society of Nephrology Meeting 1989. 5. Baur M, Schmid TO, Landauer B. Role of phospholipase A in multi organ failure with special reference to ARDS and acute renal failure (ARF). Klin Wochenschr 1989; 67:196-202. 6. Smith GM, Ward RL, McGuigan L, Rajkovie IA, Scott KF, M easurement of human phospholipase A2 in ar thritis plasm a using a newly developed sandwich ELISA. Br J Rheumatol 1992; 31:175-8. 7. Funakoshi A, Furukawa M, Yamada Y, et aL Clinical studies of serum phospholipase A 2 immunoreactivity. Nippon Shokakibyo Gakkai Zasshi 1989; 86:1136-40. 8. Costello J, Franson RC, Landwehr K, Landwehr DM. Activity of phospholipase A2 in plasma increases in uraemia, Clin Chem 1990; 36:198-200. 9. Pruzanski W, Keystone EC, Sternby B, Bombardier C, Snow KM, Vadas P. Serum phospholipase A2 corre lates w ith disease activity in rheumatoid arthritis. J Rheumatol 1988; 15:1351-5. 10. Vadas P, Pruzanski W, Stefanski E. Extracellular phospholipase A2: causative agent in circulatory col lapse of septic shock? Agents Actions 1988; 24:320-5. 11. Breborowicz A, Sombolos K, Rodela H, Ogilivie R, Bargman J, Oreopou...

Objectives To study longitudinal changes in trans-capillary ultrafiltration (TCUF) and marker clearance (MC), as a reflection of lymphatic absorption, in children on peritoneal dialysis (PD). To present data on fluid kinetics in infants younger than 2.5 years, using an intraperitoneal volume of 1200 mL/m2 body surface area (BSA). Design The study involved a 4-hour dwell of 1200 mL/m2 BSA of dialysis fluid containing 3.86% glucose with Dextran 70 as volume marker. Cumulative TCUF and cumulative MC were measured. Setting A tertiary-care university hospital. Patients A follow-up period of 33 months of serial (1 – 4) peritoneal equilibration tests (PETs) was studied in 20 children with a median age of 6.4 years (range 2.1 – 15.4 years). Fluid kinetics in 5 additional infants with a median age of 1.4 years (range 0.5 – 2.5 years) was measured. Results Cumulative TCUF was 1041 mL/1.73 m2 at 1 – 3 months after start of PD, 1026 mL/1.73 m2 at 7 – 9 months, 1021 mL/1.73 m2 at 11 – 13 months, and 756 mL/ 1.73 m2 at 26 – 33 months (NS). Cumulative MC was 235 mL/1.73 m2 at 1 – 3 months after start of PD, 311 mL/ 1.73 m2 at 7 – 9 months, 395 mL/1.73 m2 at 11 – 13 months, and 509 mL/1.73 m2 at 26 – 33 months (NS). In infants, cumulative TCUF was 755 ± 237 mL/1.73 m2; cumulative MC was 400 ± 214 mL/1.73 m2. Conclusions Transcapillary ultrafiltration and marker clearance do not change in children > 2.5 years during the period studied. Fluid kinetics does not differ between infants < 2.5 years and older children when intraperitoneal volumes of 1200 mL/m2 BSA are used.