The Necessity of Adjusting Dialysate Volume to Body Surface Area in Pediatric Peritoneal Equilibration Tests

Boer, A.W. de; Schaijk, T. C. J. G. Van; Willems, Hans L.; Reddingius, Roel E.; Monnens, L.A.H.; Schröder, Cornelis H.

doi:10.1177/089686089701700219

Cited by 15 publications

(5 citation statements)

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“…In our PD program we were able to study 5 infants with a mean age of 1.6 years: cumulative TCUF during the 4-hour dwell was 755 ± 237 mL/1.73 m 2 and cumulative MC was 400 ± 214 mL/1.73 m 2 . These results are not significantly different from the data obtained in children older than 2.5 years as described previously (5). Cumulative TCUF in the last group was 935 ± 202 mL/ 1.73 m 2 (p = 0.13) and cumulative MC was 438 ± 275 mL/1.73 m 2 (p = 0.78).…”

Section: Discussionsupporting

confidence: 50%

“…Since December 1994, PETs in our department have been performed using dialysate volumes adjusted to body surface area (BSA) because the surface area of the peritoneal membrane is related to BSA (4). In this way the results of peritoneal fluid kinetics, TCUF, and MC in children of different age groups can be compared (5). For infants younger than 2.5 years, no information is yet available on fluid kinetics during PET with an intraperitoneal (IP) volume of 1200 mL/m 2 BSA.…”

mentioning

confidence: 99%

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Follow-Up Study of Peritoneal Fluid Kinetics in Infants and Children on Peritoneal Dialysis

Boer

Schaijk²,

Willems³

et al. 1999

Perit Dial Int

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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.

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Section: Discussionsupporting

confidence: 50%

mentioning

confidence: 99%

Follow-Up Study of Peritoneal Fluid Kinetics in Infants and Children on Peritoneal Dialysis

Boer

Schaijk²,

Willems³

et al. 1999

Perit Dial Int

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“…Unfortunately, this approach led to prescriptions characterized by relatively small fill volumes. This limited fill volume concept also resulted in the false perception of the existence of differences in peritoneal permeability between children and adults, with a hyperpermeable peritoneal state presumably present in the youngest patients, especially in infants [ 25 – 27 ]. All of this could be explained by the “geometry of diffusion”, a concept that addresses the rapid equilibration of solute that occurs across the peritoneal membrane when using small fill volumes.…”

Section: Determination Of Exchange Fill Volumementioning

confidence: 99%

Peritoneal dialysis prescription in children: bedside principles for optimal practice

Fischbach¹,

Warady

2009

Pediatr Nephrol

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There is no unique optimal peritoneal dialysis prescription for all children, although the goals of ultrafiltration and blood purification are universal. In turn, a better understanding of the physiology of the peritoneal membrane, as a dynamic dialysis membrane with an exchange surface area recruitment capacity and unique permeability characteristics, results in the transition from an empirical prescription process based on clinical experience alone to the potential for a personalized prescription with individually adapted fill volumes and dwell times. In all cases, the prescribed exchange fill volume should be scaled for body surface area (ml/m 2 ), and volume enhancement should be conducted based on clinical tolerance and intraperitoneal pressure measurements (IPP; cmH 2 O). The exchange dwell times should be determined individually and adapted to the needs of the patient, with particular attention to phosphate clearance and ultrafiltration capacity. The evolution of residual kidney function and the availability of new, more physiologic, peritoneal dialysis fluids (PDFs) also influence the prescription process. An understanding of all of these principles is integral to the provision of clinically optimal PD.

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“…However, others were not able to confirm this (9,10). These conflicting results are likely to be caused by differences in standardization of the instilled volume, either per kilogram body weight or per square meter body surface area (11). The results of MTAC measurements in children have not been reported frequently.…”

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Standard Peritoneal Permeability Analysis in Children

Bouts¹,

Davin²,

Groothoff³

et al. 2000

Journal of the American Society of Nephrology

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Abstract. Peritoneal transport characteristics in children on peritoneal dialysis (PD) has been reported to be different compared to adults. However, various test methods can influence this difference. Thirty-one standard peritoneal permeability analyses (SPA) were performed in 18 PD children with a median (range) age of 9.8 yr (2 to 19) and a median duration of PD of 2.6 yr (0.19 to 6.8). The median mass transfer area coefficient (MTAC) for creatinine was 9.6 ml/min per 1.73 m2 (4.4 to 18.0), and for urea 17.3 ml/min per 1.73 m2 (12.2 to 22.8). The median dialysate to plasma creatinine ratio (D/PCr) was 0.69 (0.44 to 0.92), the glucose absorption 59% (23 to 75), and the D/D0 for glucose 0.38 (0.23 to 0.62). The median clearance of β2-microglobulin was 923 μl/min per 1.73 m2 (366 to 1828), of albumin 103 μl/min per 1.73 m2 (55 to 211), of IgG 48 μl/min per 1.73 m2 (20 to 105), and of α2-macroglobulin 12 μl/min per 1.73 m2 (5 to 49). No correlation was found between these results and age or PD time. The restriction coefficient for macromolecules indeed increased with duration of PD treatment (r = 0.38, P = 0.03). The median transcapillary ultrafiltration rate was 1.2 ml/min per 1.73 m2 (-0.01 to 2.8), the net ultrafiltration rate 0.2 ml/min per 1.73 m2 (-1.97 to 1.82), and the effective lymphatic absorption rate 1.04 ml/min per 1.73 m2 (-0.06 to 2.91). When corrected for body surface area, no differences were found in peritoneal fluid and solute transport characteristics between children and adults. No effect of time on PD on the transport parameters was found in a cross-sectional analysis, except for an increase of the restriction coefficient to macromolecules. This finding is similar to observations in adults. Therefore, the present study showed no evidence for the common belief that the peritoneal membrane in children is different from that in adult patients.

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The Necessity of Adjusting Dialysate Volume to Body Surface Area in Pediatric Peritoneal Equilibration Tests

Cited by 15 publications

References 4 publications

Follow-Up Study of Peritoneal Fluid Kinetics in Infants and Children on Peritoneal Dialysis

Follow-Up Study of Peritoneal Fluid Kinetics in Infants and Children on Peritoneal Dialysis

Peritoneal dialysis prescription in children: bedside principles for optimal practice

Standard Peritoneal Permeability Analysis in Children

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