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.
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