Continuous flow peritoneal dialysis (CFPD) improves ultrafiltration in children with acute kidney injury on conventional PD using a 4.25 % dextrose solution

Abstract

Criticism against the use of acute peritoneal dialysis (PD) has been its low clearance and low ultrafiltration (UF) volumes compared to extracorporeal techniques. The aim of our study was to determine whether continuous flow peritoneal dialysis (CFPD) would improve UF in children with acute kidney injury (AKI) in cases where UF on conventional PD was inadequate using 4.25% glucose concentrations. Five infants were prospectively studied. All had AKI with fluid overload. The median age of the patients was 6 (range 0.43-9) months; the median weight was 6.5 (range 2.7-8.4) kg. Each patient served as his or her own control, undergoing both CFPD and conventional PD. CFPD was performed with two bedside-placed catheters using a 2.5% glucose concentration. After initial filling, a dialysate flow rate of 100ml/min/1.73m(2) was maintained with an adapted continuous venovenous haemofiltration machine. The UF flow rate was set at 2.5ml/min/1.73m(2) and adapted as necessary. UF and clearance rates were measured for both PD and CFPD. The median UF rate achieved was 1.7 (range 0.01-5.30) mg/kg/h with conventional PD versus 6.7 (range 2.17-15.7) mg/kg/h with CFPD (p = 0.042). The clearances of urea and creatinine were 6.89(range 4.50-7.55) and 7.46 (range 4.79-10.50)mL/min/1.73m(2), respectively, with conventional PD and 19 (17.0-30.0) and 41 (standard deviation17.4, range 12.0-52.0) mL/min/1.73m(2), respectively, with CFPD (both p = 0.043). Continuous flow peritoneal dialysis improves UF in fluid overloaded infants who are not achieving adequate UF on conventional PD.