Abstract
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/m2), and volume enhancement should be conducted based on clinical tolerance and intraperitoneal pressure measurements (IPP; cmH2O). 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.
Highlights
There is no unique optimal peritoneal dialysis prescription for all children, the goals of ultrafiltration and blood purification are universal
The permeability of the peritoneum and the surface area membrane recruitment capacity [1] should be determined as part of the prescription process
Knowledge about the contact surface area recruitment capacity [2, 3], the so called “wetted” membrane, and vascular surface area changes [4, 5], is important because of the desire to prevent hyperperfusion of the peritoneal membrane, as it may contribute to the development of membrane failure [6,7,8]
Summary
The personal dialysis capacity (PDC) test [42], which is based on the three-pore model [16] and which is validated in adults and in children [43], describes the peritoneal membrane transport characteristics by functional parameters, derived from data obtained following several exchanges of different duration and different glucose concentrations performed over an entire day. If the new, more physiological, dialysis solutions are clearly shown to improve peritoneal membrane function in humans [19, 21, 57], their preferential use in children should complement improvements in technology They will enhance our greater understanding of factors that alter the structure and function of the peritoneal membrane to improve the prescription process for the benefit of the pediatric patient who has a lifetime of ESRD care before them
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