Icodextrin re-absorption varies with age in children on automated peritoneal dialysis

Dart, Allison; Feber, Janusz; Wong, Hubert; Filler, Guido

doi:10.1007/s00467-004-1783-7

Cited by 36 publications

(11 citation statements)

References 11 publications

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“…However, it may be associated with greater protein loss [5]. Moreover, UF with icodextrin may correlate with age in very young patients (median age 2.8 years, range 1-8 years) [48]. They may reabsorb icodextrin even with a dwell time of 6 h and thus require much shorter dwell times of 3-6 h, unlike adults and older children [48].…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, UF with icodextrin may correlate with age in very young patients (median age 2.8 years, range 1-8 years) [48]. They may reabsorb icodextrin even with a dwell time of 6 h and thus require much shorter dwell times of 3-6 h, unlike adults and older children [48]. In contrast, long-term clinical experience with icodextrin in adults now extends over many years in Europe, and icodextrin has been demonstrated to extend PD technique survival in patients with UF failure [49].…”

Section: Methodsmentioning

confidence: 99%

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Pathogenesis and treatment of peritoneal membrane failure

Saxena

2008

Pediatr Nephrol

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Peritoneal dialysis (PD) is a viable treatment option for end stage renal disease (ESRD) patients worldwide. PD may provide a survival advantages over hemodialysis (HD) in the early years of treatment. However, the benefits of PD are short-lived, as peritoneal membrane failure ensues in many patients, owing mainly to structural and functional changes in the peritoneal membrane from the use of conventional bio-incompatible PD solutions, which are hyperosmolar, acidic, have lactate buffer and contain high concentrations of glucose and glucose degradation products (GDPs). Current data suggest that chronic exposure of the peritoneum to contemporary PD fluids provokes activation of various inflammatory, fibrogenic and angiogenic cytokines, interplay of which leads to progressive peritoneal fibrosis, vasculopathy and neoangiogenesis. There is emerging evidence that peritoneal vascular changes are mainly responsible for increased solute transport and ultrafiltration failure in long-term PD. However, the precise pathophysiologic mechanisms initiating and propagating peritoneal fibrosis and angiogenesis remain elusive. The protection of the peritoneal membrane from long-term toxic and metabolic effects of high GDP-containing, conventional, glucose-based solutions is a prime objective to improve PD outcome. Recent development of new, more biocompatible, PD solutions should help to preserve peritoneal membrane function, promote ultrafiltration, improve nutritional status and, hopefully, preserve peritoneal membrane and improve overall PD outcomes. Elucidation of molecular mechanisms involved in the cellular responses leading to peritoneal fibrosis and angiogenesis spurs new therapeutic strategies that might protect the peritoneal membrane against the consequences of longstanding PD.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pathogenesis and treatment of peritoneal membrane failure

Saxena

2008

Pediatr Nephrol

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“…Studies in pediatric patients showed the same UF profile as in adults and a significant increase in solute removal. A positive correlation between age and net UF was reported in a small group of patients, with negative UF in infants characterized as high transporters on PET [69]. Since icodextrin only acts via small pores and not via AQP1, sodium sieving does not occur.…”

Section: Osmotic Agentsmentioning

confidence: 90%

Peritoneal Dialysis in Children

Patel

Kv³

et al. 2015

Pediatric Nephrology

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In children with chronic kidney disease stage 5D peritoneal dialysis (PD) remains the dialysis modality most commonly prescribed, especially as automated PD. Nowadays it can be started from the first days of life on, and applied even to some preterm babies. This chapter gives an overview on PD membrane ultrastructure and function, on technical prerequistes of PD, on optimal PD prescription and on specific treatment targets and tools to monitor efficacy. It describes PD related infectious and noninfectious complications, long term peritoneal and systemic sequelae and current state of the art of how these can be mitigated or even be prevented.

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“…After icodextrin discontinuation the plasma levels of the metabolites return to baseline within 3-7 days [69]. Icodextrin resorption has been studied in only a few children and appears to be faster in infants [73], suggesting a poorer ultrafiltration response compared with adults. The reduced GDP content improves peritoneal host defense mechanisms in an ex vivo model, but not to a similar extent to that of double-chamber PD fluids [54].…”

Section: Icodextrin Solutionmentioning

confidence: 99%

Solutions for peritoneal dialysis in children: recommendations by the European Pediatric Dialysis Working Group

Schmitt

Bakkaloğlu

Klaus³

et al. 2011

Pediatr Nephrol

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The purpose of this article is to provide recommendations on the choice of peritoneal dialysis (PD) fluids in children by the European Pediatric Dialysis Working Group. The literature on experimental and clinical studies with PD solutions in children and adults was analyzed together with consensus discussions within the group. A grading was performed based on the international KDIGO nomenclature and methods. The lowest glucose concentration possible should be used. Icodextrin may be applied once daily during the long dwell, in particular in children with insufficient ultrafiltration. Infants on PD are at risk of ultrafiltration-associated sodium depletion, while anuric adolescents may have water and salt overload. Hence, the sodium chloride balance needs to be closely monitored. In growing children, the calcium balance should be positive and dialysate calcium adapted according to individual needs. Limited clinical experience with amino acid-based PD fluids in children suggests good tolerability. The anabolic effect, however, is small; adequate enteral nutrition is preferred. CPD fluids with reduced glucose degradation products (GDP) content reduce local and systemic toxicity and should be preferred whenever possible. Correction of metabolic acidosis is superior with pH neutral bicarbonate-based fluids compared with single-chamber, acidic, lactate-based solutions. Prospective comparisons of low GDP solutions with different buffer compositions are still few, and firm recommendations cannot yet be given, except when hepatic lactate metabolism is severely compromised.

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Icodextrin re-absorption varies with age in children on automated peritoneal dialysis

Cited by 36 publications

References 11 publications

Pathogenesis and treatment of peritoneal membrane failure

Pathogenesis and treatment of peritoneal membrane failure

Peritoneal Dialysis in Children

Solutions for peritoneal dialysis in children: recommendations by the European Pediatric Dialysis Working Group

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