Peritoneal dialysis in children: Pathophysiological approaches, prescription and management of complications for adequate treatment.
DOI:
https://doi.org/10.25796/bdd.v8i2.87081Keywords:
peritoneal dialysis, pediatrics, dialysis prescription, advantages and disadvantages, renal failureAbstract
Peritoneal dialysis (PD) is the most commonly used renal replacement therapy in children worldwide. It utilizes the peritoneal membrane as a semi-permeable surface for the exchange of solutes and water between the dialysate and peritoneal capillaries. There are two main modalities: continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), the latter being performed at home using a cycler.
Pediatric prescriptions must be individualized based on body surface area, intraperitoneal pressure (IPP), and specific dialysis needsPD is generally well tolerated and offers several advantages, such as better preservation of residual diuresis, the possibility of home-based treatment, and the continuity of schooling. It also doesn’t require anticoagulation. However, it may lead to mechanical complications (hernias, leaks, pain) and infectious ones (peritonitis, catheter-related infections),some times more frequent than in adults.
Placement of an appropriate catheter (e.g., Tenckhoff) under sterile conditions with antibiotic prophylaxis is crucial for effective and safe treatment. The adequation of dialysis take into acount the choice of dialysis solution (glucose, icodextrin, bicarbonate or lactate buffer) and prescription parameters (volume, dwell time, number of cycles) should aim to optimize clearance while preserving peritoneal membrane function, but also maintain normal child weight and height growth. PD is the technique of choice in pediatrics, PD remains a flexible, effective, and suitable alternative, especially for young children or when access to hemodialysis is limited.
References
1. Bonthuis M, Vidal E, Bjerre A, Aydoğ Ö, Baiko S, Garneata L, et al. Ten-year trends in epidemiology and outcomes of pediatric kidney replacement therapy in Europe: data from the ESPN/ERA-EDTA Registry. Pediatr Nephrol Berl Ger. 2021 Aug;36(8):2337–48. DOI: https://doi.org/10.1007/s00467-021-04928-w
2. Warady BA, Schaefer F, Bagga A, Cano F, McCulloch M, Yap HK, et al. Prescribing peritoneal dialysis for high-quality care in children. Perit Dial Int J Int Soc Perit Dial. 2020 May;40(3):333–40. DOI: https://doi.org/10.1177/0896860819893805
3. Vrtovsnik F. Le péritoine : une membrane filtrante. Bull Académie Natl Médecine [Internet]. 2022 Feb 1 [cited 2025 May 5];206(2):187–94. Available from: https://www.sciencedirect.com/science/article/pii/S0001407921004325 DOI: https://doi.org/10.1016/j.banm.2021.10.008
4. Chagnac A, Herskovitz P, Weinstein T, Elyashiv S, Hirsh J, Hammel I, et al. The peritoneal membrane in peritoneal dialysis patients: estimation of its functional surface area by applying stereologic methods to computerized tomography scans. J Am Soc Nephrol JASN. 1999 Feb;10(2):342–6. DOI: https://doi.org/10.1681/ASN.V102342
5. Fischbach M, Dheu C, Helms P, Terzic J, Michallat AC, Laugel V, et al. The Influence of Peritoneal Surface Area on Dialysis Adequacy. Perit Dial Int [Internet]. 2005 Feb 1 [cited 2025 May 5];25(3_suppl):137–40. Available from: https://doi.org/10.1177/089686080502503S36 DOI: https://doi.org/10.1177/089686080502503S36
6. Fischbach M, Warady BA. Peritoneal dialysis prescription in children: bedside principles for optimal practice. Pediatr Nephrol Berl Ger. 2009 Sep;24(9):1633–42; quiz 1640, 1642. DOI: https://doi.org/10.1007/s00467-008-0979-7
7. Rippe B, Stelin G. How does peritoneal dialysis remove small and large molecular weight solutes? Transport pathways: fact and myth. Adv Perit Dial Conf Perit Dial. 1990;6:13–8.
8. Ranchin B, Schmitt CP, Warady B, Craig JC, Licht C, Hataya H, et al. Devices for long-term hemodialysis in small children-a plea for action. Kidney Int. 2023 Jun;103(6):1038–40. DOI: https://doi.org/10.1016/j.kint.2023.03.018
9. Burgmaier K, Hackl A, Ehren R, Kribs A, Burgmaier M, Weber LT, et al. Peritoneal dialysis in extremely and very low-birth-weight infants. Perit Dial Int J Int Soc Perit Dial. 2020 Mar;40(2):233–6. DOI: https://doi.org/10.1177/0896860819887292
10. Huang CC, Cheng KF, Wu HDI. Survival analysis: comparing peritoneal dialysis and hemodialysis in Taiwan. Perit Dial Int J Int Soc Perit Dial. 2008 Jun;28 Suppl 3:S15-20. DOI: https://doi.org/10.1177/089686080802803s04
11. Shaw V, Polderman N, Renken-Terhaerdt J, Paglialonga F, Oosterveld M, Tuokkola J, et al. Energy and protein requirements for children with CKD stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol Berl Ger. 2020 Mar;35(3):519–31. DOI: https://doi.org/10.1007/s00467-019-04426-0
12. Bechara R, Rossignol S, Zaloszyc A. [Chronic kidney disease and growth failure: Efficacy of growth hormone treatment]. Med Sci MS. 2023 Mar;39(3):271–80. DOI: https://doi.org/10.1051/medsci/2023034
13. Hajj E, Awouters M, Mosca M, Flammier S, Rachedi S, Bacchetta J, et al. Health-related quality of life in paediatric patients on peritoneal dialysis: Data from a tertiary centre. Perit Dial Int J Int Soc Perit Dial. 2025 Mar;45(2):121–3. DOI: https://doi.org/10.1177/08968608241241177
14. Lima AGT, Sales CC da S, Serafim WF de L. Burden, depression and anxiety in primary caregivers of children and adolescents in renal replacement therapy. J Bras Nefrol. 2019;41(3):356–63. DOI: https://doi.org/10.1590/2175-8239-jbn-2018-0039
15. Goffin E. Peritoneal membrane structural and functional changes during peritoneal dialysis. Semin Dial. 2008;21(3):258–65. DOI: https://doi.org/10.1111/j.1525-139X.2008.00425.x
16. Wisanuyotin S, Dell KM, Vogt BA, O’Riordan MA, Avner ED, Davis ID. Complications of peritoneal dialysis in children with Eagle-Barrett syndrome. Pediatr Nephrol Berl Ger. 2003 Feb;18(2):159–63. DOI: https://doi.org/10.1007/s00467-002-1034-8
17. Briggs VR, Jacques RM, Fotheringham J, Maheswaran R, Campbell M, Wilkie ME. Catheter insertion techniques for improving catheter function and clinical outcomes in peritoneal dialysis patients. Cochrane Database Syst Rev. 2023 Feb 22;2(2):CD012478. DOI: https://doi.org/10.1002/14651858.CD012478.pub2
18. Warady BA, Same R, Borzych-Duzalka D, Neu AM, El Mikati I, Mustafa RA, et al. Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update. Perit Dial Int J Int Soc Perit Dial. 2024 Sep;44(5):303–64. DOI: https://doi.org/10.1177/08968608241274096
19. Sethna CB, Bryant K, Munshi R, Warady BA, Richardson T, Lawlor J, et al. Risk Factors for and Outcomes of Catheter-Associated Peritonitis in Children: The SCOPE Collaborative. Clin J Am Soc Nephrol CJASN. 2016 Sep 7;11(9):1590–6. DOI: https://doi.org/10.2215/CJN.02540316
20. Katyal A, Mahale A, Khanna R. Antibiotic prophylaxis before peritoneal dialysis catheter insertion. Adv Perit Dial Conf Perit Dial. 2002;18:112–5.
21. Keane WF, Bailie GR, Boeschoten E, Gokal R, Golper TA, Holmes CJ, et al. Adult peritoneal dialysis-related peritonitis treatment recommendations: 2000 update. Perit Dial Int J Int Soc Perit Dial. 2000;20(4):396–411. DOI: https://doi.org/10.1177/089686080002000406
22. Schaefer F, Klaus G, Müller-Wiefel DE, Mehls O. Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol JASN. 1999 Jan;10(1):136–45. DOI: https://doi.org/10.1681/ASN.V101136
23 Fischbach, M., Issad, B., Dubois, V., & Taamma, R. (2011). The beneficial influence on the effectiveness of automated peritoneal dialysis of varying the dwell time (short/long) and fill volume (small/large): a randomized controlled trial. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 31(4), 450–458. https://doi.org/10.3747/pdi.2010.00146 DOI: https://doi.org/10.3747/pdi.2010.00146
24. Twardowski ZJ, Nolph KD, Khanna R, Prowant BF, Ryan LP, Moore HL, Nielsen MP. «Peritoneal Equilibration Test.» Peritoneal Dialysis Bulletin. 1987;7(3):138–147. DOI: https://doi.org/10.1177/089686088700700306
25. Verger C. How to use the peritoneum as a dialysis membrane. Methods of surveillance, criteria of efficacy and longevity as a dialysis membrane, consequences with respect to techniques of peritoneal dialysis. Nephrologie. 1995;16(1):19–31.
26. Fischbach M. Peritoneal dialysis in children. Arch Pediatr Organe Off Soc Francaise Pediatr. 1997 Jan;4(1):81–9.
27. Radtke J, Lemke A, Kemper MJ, Nashan B, Koch M. Surgical complications after peritoneal dialysis catheter implantation depend on children’s weight. J Pediatr Surg [Internet]. 2016 Aug [cited 2025 May 23];51(8):1317–20. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346815008234 DOI: https://doi.org/10.1016/j.jpedsurg.2015.12.005
28. Laakkonen H, Hölttä T, Lönnqvist T, Holmberg C, Rönnholm K. Peritoneal dialysis in children under two years of age. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 2008 May;23(5):1747–53.
29. Tse KC, Yip PS, Lam MF, Li FK, Choy BY, Chan TM, et al. Recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial. 2002;22(4):488–91. DOI: https://doi.org/10.1177/089686080202200407
30. García Ramón R, Carrasco AM. Hydrothorax in peritoneal dialysis. Perit Dial Int J Int Soc Perit Dial. 1998;18(1):5–10. DOI: https://doi.org/10.1177/089686089801800101
31. Mactier RA, Sprosen TS, Gokal R, Williams PF, Lindbergh M, Naik RB, et al. Bicarbonate and bicarbonate/lactate peritoneal dialysis solutions for the treatment of infusion pain. Kidney Int. 1998 Apr;53(4):1061–7. DOI: https://doi.org/10.1046/j.1523-1755.1998.00849.x
32. Blake PG, Sloand JA, McMurray S, Jain AK, Matthews S. A multicenter survey of why and how tidal peritoneal dialysis (TPD) is being used. Perit Dial Int J Int Soc Perit Dial. 2014 Jun;34(4):458–60. DOI: https://doi.org/10.3747/pdi.2013.00314
33. Zaritsky JJ, Hanevold C, Quigley R, Richardson T, Wong C, Ehrlich J, et al. Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative. Pediatr Nephrol Berl Ger. 2018 Apr;33(4):713–22. DOI: https://doi.org/10.1007/s00467-017-3839-5
34. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, et al. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int J Int Soc Perit Dial. 2012 Jun;32 Suppl 2(Suppl 2):S32-86. DOI: https://doi.org/10.3747/pdi.2011.00091

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