Peritoneal Dialysis International, Vol.18, pp /98 $ TRANSPORT KINETICS IN CHILDREN

Size: px
Start display at page:

Download "Peritoneal Dialysis International, Vol.18, pp /98 $ TRANSPORT KINETICS IN CHILDREN"

Transcription

1 Peritoneal Dialysis International, Vol.18, pp /98 $ Printed in Canada All rights reserved Copyright 1998 International Society for Peritoneal Dialysis INFLUENCE OF AGE, TIME, AND PERITONITIS ON PERITONEAL TRANSPORT KINETICS IN CHILDREN Tuula M. Hölttä, Kai A.R. Rönnholm, Christer Holmberg Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.Objective:To evaluate peritoneal transport kinetics and its changes over time in children with and without peritonitis, and to record possible differences between children under and over 5.0 years of age..design: A prospective study. The patients underwent a 4- hour peritoneal equilibration test (PET) comprising 2.27% dextrose with a dialysate fill volume of 1000 ml/m2 of body surface area (BSA), at baseline and after a mean of 0.8 :I: 0.4 years of uninterrupted dialysis..patients: We investigated 28 patients on maintenance peritoneal dialysis at baseline; 10 were under 5.0 years of age. The final PET was performed in 21 patients..main Outcome Measures: Peritoneal equilibration rates for urea (U), creatinine (C), glucose (G), sodium, potassium, phosphate, and albumin (A) were measured. Initial and final peritoneal equilibration rates were compared. Mass transfer area coefficients (MTAC) were calculated for urea, creatinine, glucose, and albumin. Residual dialysate volume was determined..results: Median age at first PET was 7.6 years (range yr). The mean (±1 SD) 4-hour dialysate-toplasma (DIP) ratios for U, C, and A were 0.92:1: 0.05,0.70 ± 0.12, and :I: 0.007, respectively. The mean 4-hour DIDo ratio for G was 0.32 :I: DIP and DIDo results were similar in the two age groups, and peritoneal membrane function remained stable over the study period. Mean MTAC (:1:1 SD) values were: U, 22.3 :I: 4.8; C, 10.9 :I: 4.1; G, 11.1 :I: 3.3; and A, 0.07 :I: MTAC data were similar in the two age groups and no significant changes occurred during the study period..conclusions: When the volume tested in children is proportional to BSA, the solute DIP ratios seem to be ageindependent. Our data provide evidence that in pediatric patients MTAC is also age-independent. KEY WORDS: Children; peritoneal equilibration; kinetics; mass transfer area coefficient; MTAC. T he peritoneal equilibration test (PET) has been developed to evaluate baseline peritoneal solute transport rates, and to determine an individual's op Correspondence to: T.M. Hölttä, Hospital for Children and Adolescents, University of Helsinki, Stenbäckinkatu 11, FIN Helsinki, Finland. Received 5 June 1998; accepted 9 September timal peritoneal dialysis (PD) regimen. Twardowski et al. (1) classified the test for adult use. The PET has also been used in pediatric patients, but its application has been controversial and problematic. During recent years consensus has been reached that PET should be performed with a volume calculated according to body surface area (BSA), since this is proportional to the surface area of the peritoneal membrane (2). Previous studies demonstrated a trend toward more rapid glucose absorption in small children (35). However, in these studies the test volume was related to body weight. One could argue that this difference is an artefact induced by the smaller fluid volume compared with the peritoneal membrane surface area, leading to more rapid peritoneal equilibration because of the relatively smaller intraperitoneal volume in smaller children. This phenomenon was documented in two recent studies (6,7) made with different test volumes scaled to BSA. Only a few studies have attempted to investigate whether there are differences in peritoneal equilibration between children of various ages when intraperitoneal volumes are related to BSA. Thus, it is still unclear whether peritoneal equilibration is age-related or not. In 1994 Sliman et al. (8) demonstrated an inverse correlation between peritoneal equilibration and age. In 1996 Waradyet al. (9) showed that equilibration was similar in different age groups. The ageindependence of peritoneal equilibration was confirmed by de Boer et al. (10) in 1997; they found fluid kinetics to be independent of age in children over 3 years of age. Little data on the impact of peritonitis on membrane permeability are available in pediatric patients. Also, the possible changes in membrane permeability with time are unknown. The mass transfer area coefficient (MTAC), which characterizes the diffusive permeability of the peritoneal membrane, has been evaluated in only a few pediatric studies. Although MTAC is thought to be dialysate volume independent (2), Keshaviah et al., in an adult study, demonstrated MTAC to increase with increasing dialysate volume (11). However, the

2 volume independence was demonstrated by Warady et al. for intraperitoneal volumes of 900 and 1100 ml/m2 in pediatric patients (6). In the same study, age-related differences in MTAC were found (9). In another pediatric study, Geary et al. found that MTAC values per kilogram body weight were inversely correlated to age, and did not approach adult values until later childhood (12). However, the test volume used by Geary et al. was low (approximately 30 ml/kg) and correlated to body weight instead of BSA, which makes comparison with adult values difficult. Knowledge of the stability of MTAC from exchange to exchange is still lacking. We have previously reported our experience with PD in children under 5 years of age (13). To characterize peritoneal membrane function, and find possible age and time-related differences in peritoneal transport kinetics, we began to include regular PETs in our dialysis program in Here we report our experience with PET performed regularly in 28 children on maintenance PD between April 1995 and December PATIENTS AND METHODS Twenty-eight patients (18 boys, 10 girls) on maintenance PD were studied. The results in children under 5.0 years of age were compared with those in older children. The initial and final PET results were also compared to record any changes in peritoneal membrane function with treatment time and after episodes of peritonitis. The median age at the time of the first PET was 7.6 years (range yr); 10 patients were under 5.0 years of age (1.7 ± 1.3 yr); and 18 were over 5.0 years old (11.2 ± 3.8 yr). Twenty-five were on continuous cyclic peritoneal dialysis (CCPD) and 3 were on tidal peritoneal dialy sis (TPD) at the time of their first PET. Mean dialysis time prior to the first PET was 0.4 ± 0.4 years (range yr). Underlying renal diseases were congenital nephrotic syndrome of the Finnish type (CNF) in 10, cystic kidney disease and obstructive uropathy in 3 patients each, prunebelly and Wegener's granulomatosis in 2 patients each, and Denys Drash syndrome, Alport's syndrome, rapidly progressive glomerulonephritis, IgA nephropathy, lupus erythematosus disseminatus, reflux nephropathy, dysplasia fibromuscularis arterialis, and optic nerve coloboma with renal disease in 1 patient each. Two of the patients (both over 5.0 years) were in cluded twice. In 1, the underlying renal disease was Wegener's granulomatosis; he was without PD for 1 year after kidney transplantation. The other had CNF; she was without PD for 4 months for the same reason. We checked that the inclusion of these patients twice did not skew the data. The PET was always performed at least 1 month after completing antibiotic therapy for peritonitis. Peritonitis therapy in patients treated outside our institution consisted of a loading dose of vancomycin (15 mg/kg) and netilmycin (1.8 mg/kg) intraperitone ally for 2 hours, followed by approximately 8-12 daily exchanges of dialysate containing 30 mg/l vancomycin and 8 mg/l netilmycin. Patients treated at our institution received intermittent intraperitoneal antibiotic treatment: vancomycin in a dose of30 mg/kg in one 6-hour exchange 2 times every 5 7 days, and netilmycin 20 mg/l using once-daily dosing. Antibiotics were later adjusted according to the microbial findings and continued for 8 10 days. Some (53%) of the peritonitis episodes were treated using intermittent therapy and the rest continuously. The final PET was defined as the last PET before kidney transplantation or the last performed before the end of December 1997 in those children who were still on PD. It was performed in mean 2.9 ± 0.2 months (n = 3),5. 7 ± 1.0 mth (n = 5),9.0 ± 0.7 mth (n = 6), 11.6 ± 0.9 mt h (n = 3), 15.2 mth (n = 1), and 19.0 ± 1.1 mth (n = 3) after initial PET, respectively. A 4-hour PET was performed with 1000 ml/m2 BSA of a PD solution containing 2.27% dextrose (Dianeal 2.27%, Baxter Healthcare, Castlebar, Ire land) after an 8-hour dwell with PD solution of the same amount and concentration. During the infu sion the patients were in the supine position, turning from side to side. Immediately after completion of the infusion, 10% of the volume was drained and mixed well, and a 5-mL sample was taken. Other samples were taken after 60, 120, and 240 minutes dwell. The patients were ambulatory during the test. Mter 4 hours the total volume was drained. Ultra filtration (UF) was corrected for the total volume of samples taken during the study. A blood sample was obtained after 120 minutes dwell. The concentrations of glucose, urea, creatinine, sodium, potassium, albumin, and phosphate were determined in dialysate and blood. To achieve a physiologically consistent relationship between the blood and dialysate concentrations of the particular solute, all serum values, except albumin, were expressed as concentrations per unit volume of plasma water. This was achieved by dividing the serum values, except that of albumin, by a factor of 0.93, thereby correcting the plasma volume for protein and lipid contents (14). Sodium and potassium were measured by flame photometry in serum and with a direct ion-selective electrode in the dialysate, albumin in serum by the bromcresol purple reaction and immunoturbidometrically in the dialysate. Both blood and dialysate urea were measured by the urease method, creatinine by the kinetic Jaffe method, and phosphate by photometry. Blood glucose was measured using a

3 glucose oxidase electrode and enzymatically in the dialysate. Because a high glucose concentration in PD solutions interferes with the creatinine assay used, a correction factor was determined with the help of creatinine-free glucose solutions. Dialysate creatinine was computed as corrected creatinine (μmol/l) = creatinine (μmol/l) x dialysate glucose (mmol/l). Total body water was estimated from height and body weight, using the child-specific equation offriis Hansen (15). Body surface area was calculated using the childspecific equation of Haycock et al. (16). Peritoneal transport was estimated from the dialysate-toplasma ratios (DIP) of urea, corrected creatinine, sodium, potassium, albumin, and phosphate calculated at 0, 1,2, and 4 hours. Similarly, the transport of glucose across the peritoneum was used to estimate the ratio of dialysate glucose at a given time to the dialysate glucose level at time 0 (D/Do). Determination ofmtac was based on the two-pool Pyle-Popovich model (17), and was calculated as a weighted average: where t is time, Co is dialysate solute concentration at time 0; CD is the dialysate solute concentration at time t in minutes; CB is the average solute blood concentration at time t; Vo is the volume infused plus the pre-exchange residual volume; and V D is the geometric average ofvo and volume drained plus the preexchange residual volume. The sampling times used for MTAC calculation were 120 and 240 minutes, because of the computer model we used. Thus, the weights used for computing the weighted average of the MTAC were the squares of the sampling times at 120 and 240 minutes. All data are expressed as medians or means ± 1 SD. Statistical comparisons of normally distributed values were performed using the t-test, of distributionfree values for two independent groups using the Mann Whitney U test, and for one-sample paired readings using the Wilcoxon signed rank test. Associations between variables were evaluated by quadratic regression analysis. Any p values less than 0.05 were considered significant. RESULTS The mean test volume in the initial PET in 28 patients was 984 ± 29 ml/m2 (967 ± 31 ml/m2 in children under, and 994 ± 23 ml/m2 in children over 5.0 years of age). The mean pre-exchange residual volume was 153 ± 68 ml/m2 (181 ± 76 ml/m2 and 137 ± 59 ml/m2 for children under and over 5.0 years of age, respectively). The mean 4-hour UF was 180 ± 99 ml/m2 (173 ± 124 ml/m2 and 184 ± 86 ml/m2, respectively). Seven children had a history ofperitonitis 2.8 ± 1.6 (range ) months prior to initial PET and 21 were peritonitis -free. No significant difference in equilibration was found between these two groups. Thus, all initial PETs were pooled to construct the equilibration curves. The pooled solute equilibra tion curves for urea, creatinine, phosphate, and glucose are illustrated in Figure 1. The absolute numbers for the initial PETs in children under and over 5.0 years of age are given in Table 1. No significant difference was found between these two age groups. A final PET was performed in 21 children at a mean of 0.8 ± 0.4 (range ) years after the first PET (1.3 ± 0.8 years after initiation ofpd). The mean test volume in the final PET was 1005 ± 20 ml/m2 [1009 ± 56 ml/m2 in children under (n = 9), and 1002 ± 13 ml/m2 in children over 5.0 years of age (n = 12)]. The final mean pre-exchange residual volume was 186 ± 58 ml/m2 (201 ± 39 ml/m2 and 179 ± 68 ml/m2 for children under and over 5.0 years of age, respectively). The final mean 4-hour UF volume was 160 ± 129 ml/m2 (144 ± 157 ml/m2 and 173 ± 109 ml/m2, respectively). When the initial and final PET results were compared, slight increases were found in the DIP and D/Do ratios (Figure 2) and a decrease in the 4-hour UF, but these differences were not significant at any time point. To further investigate any longitudinal changes in peritoneal membrane function, the patients were divided into 2 groups: group 1, those with no history of peritonitis during the study period; and group 2, those with a history of at least one episode of peritonitis during the study period, irrespective of whether they had had a peritonitis more than 1 month prior to their initial PET. The incidence of peritonitis was: one episode in 3 patients, two episodes in 3 patients, and three episodes in 2 patients. The causal organisms isolated were: Staphylacaccus aureus in 7 episodes, Enterabacter in 3 episodes, Pseudamanas aeruginasa in 2 episodes (in 1 patient), and Enteracaccus, Streptacaccus viridans, and Acinetabacter calcaaceticus in 1 episode each. In the peritonitis group, the final PET was performed 4.7 ± 3.7 (range ) months after peritonitis. The mean interval between PETs was 0.72 ± 0.39 years in group 1 (n = 13) and 0.89 ± 0.50 years in group 2 (n = 8). The changes in the equilibration rates of creatinine in 4 hours for both groups are illustrated in Figure 3. The equilibration decreased in the peritonitis group only in the patient with two Pseudamanas episodes (pointed out in Figure 3, upper). There were no significant changes in the equilibration rates of creatinine or phosphate in either group with time, or in any other equilibration rates studied (data not shown).

4 Peritoneal transport kinetics in patients with CNF (10 of28 patients, 8 under 5.0 years ofage) were compared with those in other patients. Children with CNF showed a slightly higher membrane permeability for albumin in their initial PET (the mean 4-hour D/P ratio for albumin was ± in the CNF patients, and ± in the non-cnf patients). This difference in the 4-hour D/P ratio for albumin was not seen in the final PET. The children with CNF also tended to equilibrate other solutes faster in the initial PET, but this difference was reduced or had disappeared in the final PET compared with the noncnf patients. Thus, the difference in equilibration between CNF and non-cnf patients was significant only for the initial4- hour D/Do ratio of glucose (0.26 ± 0.06 and 0.35 ± 0.10, p = 0.027), and D/P ratio ofphosphate (0.65 ± 0.12 and 0.53 ± 0.11, p = 0.013). The MTAC data for urea, creatinine, glucose, and albumin are given in Table 2. There was no difference in MTAC between the children under and over 5.0 years of age, nor was there any correlation between MTAC and age in quadratic regression analy

5 SiB. When all results were pooled, no significant difference was found between the initial and final MTAC, or between subgroups of children with and without a history of peritonitis during the entire study period, although the children with a history of peritonitis tended to have a higher MTAC. The children with CNF tended to have higher initial and lower final MTACs than the other children, but these differences were not significant. This finding is compatible with the higher D/P at the initial PET compared to the final PET in the patients with CNF, as described above. DISCUSSION Our results, using an intraperitoneal volume re lated to BSA, support the age-independence of peritoneal transport kinetics in children. We found neither a significant difference in D/P ratio between the children under and over 5.0 years of age, nor a corre

6 lation between D/P and age. Although the children with CNF tended to equilibrate faster in their initial PET, the difference in D/P ratio between the patients with and those without CNF was significant only for 4-hour glucose and phosphate in the initial PET. Peritonitis 4 weeks before PET did not affect the D/P ratio. When the results of initial and final PETs were compared, peritoneal membrane function remained stable over at least 6 months. No correlation was found between MTAC and age. In our study, the 4-hour solute D/P data for glucose and sodium were similar to the Pediatric Peritoneal Dialysis Study Consortium (PPDSC) data using an intraperitoneal volume of 1100 ml/m2 ofbsa (9). Our 4-hour D/P ratio for sodium and DIDo for glucose were equal to those in the PPDSC study, but the 4-hour D/P ratio for creatinine was 6% higher, and for urea and potassium 10% higher. A possible expla nation for our slightly higher values could be the smaller test volume and the large number of children with congenital nephrosis (36%). An alternative explanation, suggesting that peritoneal equilibration decreases with time, could be the much shorter mean dialysis time prior to the initial PET in our patients; only 0.4 years compared with 2 years in the PPDSC study. Schaeferet al. (18) studied 20 pediatric patients, using the same intraperitoneal volume as we did, but without correcting plasma volume for protein and lipid content. If we recalculate our data without correction of serum values, our 4-hour D/P ratio for potassium is 9% higher and for phosphate 16% lower, while the other values remain much the same. Very few studies have measured alterations in peritoneal equilibration rate over time in pediatric patients. Nishi et al. (19) found that peritonitis was a risk factor for deterioration of peritoneal function. In 6 children aged 11 ± 8 years with a history of peritonitis, he found a significant decrease in the D/P creatinine ratio at 4-hour dwell time in the final PET compared with the initial PET (the mean interval between the PETs was 28 ± 12 months). In 6 children of similar age without peritonitis, the final4-hour D/P creatinine ratio was unchanged (the mean interval between PETs was 22 ± 12 months). However, the DIDo

7 glucose ratio at 4-hour dwell time was unchanged over time in both groups. Several adult studies, however, have failed to show changes in membrane transport after episodes of peritonitis. In an adult study, Davies et at. (20) suggest that solute transfer increases and UF decreases with time after only 6 months on PD treatment, the increase being accelerated by peritonitis. Peritonitis, especially when caused by Pseudamanas, is reported to cause reduction of peritoneal membrane function (21,22). In our study, peritoneal membrane function remained stable even after episodes of peritonitis. We had only 1 patient with Pseudamanas peritonitis and her membrane perme ability decreased. Membrane permeability in the initial PET was slightly higher in children with CNF compared to other children, but this difference disappeared in the final PET. The mean test volume was not lower in CNF patients compared to other patients, and dialysis time prior to the initial PET was similar. CNF patients have low serum albumin, prealbumin, and protein levels, and muscular hypotonia. They also have cholesterol, lipoprotein, and phospholipid abnormalities. Pre albumin normalizes after 1 month on PD. Albumin, protein, cholesterol, and lipoprotein levels do improve within 3 months, but will not reach normal values (23). In addition, children with CNF, in contrast to other predialysis patients, are not uremic. They become uremic after nephrectomy. These metabolic differences may have an impact on membrane permeability, especially during the first months on PD. Our MTAC values for urea were higher than in the PPDSC study (22.3 ± 4.8 ml/min and 18.4 ± 4.0 ml/min), and slightly lower for glucose (11.1 ± 3.3 ml/min and 12.9 ± 5.0 ml/min). The MTAC for creatinine was similar (10.9 ± 4.1 ml/min and 10.7 ± 3.7 ml/min). In the PPDSC study, more dialysate samples were taken into account for the calculations (0, 30, 60, 120, 180, and 240 minutes) compared with the 120 and 240-minute samples used by us. This makes their calculation more accurate, but probably the most important explanation of the higher MTAC for urea in our patients is the higher membrane transport rate. The PPDSC study showed significant agedependence for MTAC of glucose, whereas we failed to show any age-dependence for MTAC ofurea, creatinine, glucose, or albumin. In our study, the MTACs also remained stable over time, as did equilibration, and no differences were found in the MTACs between the groups with and without peritonitis. Our study confirms age-independence for the equilibration rates and MTACs in children when the test volume is related to BSA. Peritoneal membrane function remained stable over at least 6 months of PD therapy. In the beginning, children with CNF showed a trend toward higher peritoneal membrane permeability. However, later these children did not differ from nonnephrotic children.. In conclusion, we found that a standardized PET is repeatable and reliable when using test volumes based on BSA. On a group level, PETs, when used regularly, will be helpful for recognizing differences and alterations in peritoneal membrane function. They can thus be used to optimize PD on an individual basis, even in young children. ACKNOWLEDGMENTS This study was supported by the Sigrid Juselius Foundation, the Children's Research Foundation, and the Kidney Foundation. The authors thank Mrs. Jean Margaret Perttunen, B.Sc. (Hons.), for revising the manuscript. REFERENCES 1. Twardowski ZJ, Nolph KD, Khanna R, Prowant BF, Ryan LP, Moore HL, et al. Peritoneal equilibration test. PeritDialBull1987; 7(3): Morgenstern BZ, Baluarte HJ. Peritoneal dialysis kinetics in children. In: Fine RN, ed. Chronic ambulatory peritoneal dialysis (CAPD) and chronic cycling peritoneal dialysis (CCPD) in children. Boston: Martinus Nijhoff, 1987: Geary DF, Harvey EA, MacMillan JH, Goodman Y, Scott M, Balfe JW. The peritoneal equilibration test in children. Kidney Int 1992; 42(1): Schröder CH, van Dreumel MJ, Reddingius R, Theeuwes AGM, Willems HL, de Jong MCJW, et al. Peritoneal transport kinetics of glucose, urea, and creatinine during infancy and childhood. Perit Dial Int 1991; 11(4): Mendley SR, Majkowski NL. Peritoneal equilibration test results are different in infants, children, and adults. J Am Soc Nephrol1995; 6(4): Warady BA, Alexander S, Hossli S, Vonesh E, Geary D, Kohaut E. The relationship between intraperitoneal volume and solute transport in pediatric patients. Pediatric Peritoneal Dialysis Study Consortium. J Am Soc Nephrol1995; 5(11): Kohaut EC, Waldo FB, Benfield MR. The effect of changes in dialysate volume on glucose and urea equilibration. Perit Dial Int 1994; 14(3): Sliman GA, Klee KM, Gall-HoldenB, Watkins SL. Peritoneal equilibration test curves and adequacy of dialysis in children on automated peritoneal dialysis. Am J Kidney Dis 1994; 24(5): Warady BA, Alexander SR, Hossli S, Vonesh E, Geary D, Watkins S, et al. Peritoneal membrane transport function in children receiving long-term dialysis. J Am Soc Nephrol1996; 7(11): de Boer AW, van Schaijk TC, Willems HL, Reddingius RE, Monnens LA, Schröder CH. The necessity of adjusting dialysate volume to body surface area in pediatric peritoneal equilibration tests. Perit Dial Int 1997; 17(2): Keshaviah P, Emerson PF, Vonesh EF, Brandes JC.

8 Relationship between body size, fill volume, and mass transfer area coefficient in peritoneal dialysis. J Am Soc Nephrol1994; 4(10): Geary DF, Harvey EA, Balfe JW. Mass transfer area coefficients in children. Perit Dial Int 1994; 14(1): Hölttä TM, Rönnholm KAR, Jalanko H, Ala-Houhala M, Antikainen M, Holmberg C. Peritoneal dialysis in children under 5 years of age. Perit Dial Int 1997; 17(6): Waniewski J, Heimbürger 0, WerynskiA, Lindholm B. Aqueous solute concentrations and evaluation of mass transport coefficients in peritoneal dialysis. Nephrol DialTransplant 1992; 7(1): Friis-Hansen B. Body water compartments in children: changes during growth and related changes in body composition. Pediatrics 1961; 28(2): Haycock GB, Schwartz GJ, Wisotsky DH. Geometric method for measuring body surface area: a height weight formula validated in infants, children, and adults. J Pediatr 1978; 93(1): Vonesh EF, Lysaght MJ, Moran J, Farrell P. Kinetic modeling as a prescription aid in peritoneal dialysis. Blood Purif1991; 9: Schaefer F, Langenbeck D, Heckert KH, Scharer K, Mehls O. Evaluation of peritoneal solute transfer by the peritoneal equilibration test in children. In: Khanna R, Nolph KD, Prowant BF, Twardowski ZJ, Oreopoulos DG, eds. Advances in peritoneal dialysis. Toronto: Peritoneal Dialysis Bulletin, 1992; 8: NishiA, ItoY,AmamotoY,Aida K, Kato H. Longitudinal changes in peritoneal equilibration test with or without peritonitis in children. Pediatr Nephrol1995; 9(5): Davies SJ, Bryan J, Phillips L, Russell GI. Longitudinal changes in peritoneal kinetics: the effects of peritoneal dialysis and peritonitis. Nephrol Dial Transplant 1996; 11(3): Levy M, Balfe JW. Optimal approach to the prevention and treatment of peritonitis in children undergoing continuous ambulatory and continuous cycling peritoneal dialysis. Semin Dial 1994; 7(6): Andreoli SP, Langefeld CD, Stadler S, Smith P, Sears A, West K. Risks of peritoneal membrane failure in children undergoing long-term peritoneal dialysis. PediatrNephrol1993; 7(5): Antikainen M. Protein and lipid metabolism in nephrotic infants on peritoneal dialysis after nephrectomy. Pediatr Nephrol1993; 7(4):

The peritoneal equilibration test (PET) was developed THE SHORT PET IN PEDIATRICS. Bradley A. Warady and Janelle Jennings

The peritoneal equilibration test (PET) was developed THE SHORT PET IN PEDIATRICS. Bradley A. Warady and Janelle Jennings Peritoneal Dialysis International, Vol. 27, pp. 441 445 Printed in Canada. All rights reserved. 0896-8608/07 $3.00 +.00 Copyright 2007 International Society for Peritoneal Dialysis THE SHORT PET IN PEDIATRICS

More information

Chapter 2 Peritoneal Equilibration Testing and Application

Chapter 2 Peritoneal Equilibration Testing and Application Chapter 2 Peritoneal Equilibration Testing and Application Francisco J. Cano Case Presentation FW, a recently diagnosed patient with CKD Stage 5, is a 6-year-old boy who has been recommended to initiate

More information

3/21/2017. Solute Clearance and Adequacy Targets in Peritoneal Dialysis. Peritoneal Membrane. Peritoneal Membrane

3/21/2017. Solute Clearance and Adequacy Targets in Peritoneal Dialysis. Peritoneal Membrane. Peritoneal Membrane 3/21/2017 Solute Clearance and Adequacy Targets in Peritoneal Dialysis Steven Guest MD Director, Medical Consulting Services Baxter Healthcare Corporation Deerfield, IL, USA Peritoneal Membrane Image courtesy

More information

Objectives. Peritoneal Dialysis vs. Hemodialysis 02/27/2018. Peritoneal Dialysis Prescription and Adequacy Monitoring

Objectives. Peritoneal Dialysis vs. Hemodialysis 02/27/2018. Peritoneal Dialysis Prescription and Adequacy Monitoring Peritoneal Dialysis Prescription and Adequacy Monitoring Christine B. Sethna, MD, EdM Division Director, Pediatric Nephrology Cohen Children s Medical Center Associate Professor Hofstra Northwell School

More information

Advances in Peritoneal Dialysis, Vol. 23, 2007

Advances in Peritoneal Dialysis, Vol. 23, 2007 Advances in Peritoneal Dialysis, Vol. 23, 2007 Antonios H. Tzamaloukas, 1,2 Aideloje Onime, 1,2 Dominic S.C. Raj, 2 Glen H. Murata, 1 Dorothy J. VanderJagt, 3 Karen S. Servilla 1,2 Computation of the Dose

More information

PART ONE. Peritoneal Kinetics and Anatomy

PART ONE. Peritoneal Kinetics and Anatomy PART ONE Peritoneal Kinetics and Anatomy Advances in Peritoneal Dialysis, Vol. 22, 2006 Paul A. Fein, Irfan Fazil, Muhammad A. Rafiq, Teresa Schloth, Betty Matza, Jyotiprakas Chattopadhyay, Morrell M.

More information

PERITONEAL EQUILIBRATION TEST. AR. Merrikhi. MD. Isfahan University of Medical Sciences

PERITONEAL EQUILIBRATION TEST. AR. Merrikhi. MD. Isfahan University of Medical Sciences PERITONEAL EQUILIBRATION TEST AR. Merrikhi. MD. Isfahan University of Medical Sciences INTRODUCTION The peritoneal equilibration test (PET) is a semiquantitative assessment of peritoneal membrane transport

More information

Guidelines by an ad hoc European committee on adequacy of the paediatric peritoneal dialysis prescription

Guidelines by an ad hoc European committee on adequacy of the paediatric peritoneal dialysis prescription Nephrol Dial Transplant (2002) 17: 380 385 Special Feature Guidelines by an ad hoc European committee on adequacy of the paediatric peritoneal dialysis prescription Michel Fischbach 1, Constantinos J.

More information

02/21/2017. Assessment of the Peritoneal Membrane: Practice Workshop. Objectives. Review of Physiology. Marina Villano, MSN, RN, CNN

02/21/2017. Assessment of the Peritoneal Membrane: Practice Workshop. Objectives. Review of Physiology. Marina Villano, MSN, RN, CNN Assessment of the Peritoneal Membrane: Practice Workshop Marina Villano, MSN, RN, CNN marina.villano@fmc-na.com Objectives Briefly review normal peritoneal physiology including the three pore model. Compare

More information

Peritoneal Dialysis Prescriptions: A Primer for Nurses

Peritoneal Dialysis Prescriptions: A Primer for Nurses Peritoneal Dialysis Prescriptions: A Primer for Nurses A Primer ABCs of PD R x Betty Kelman RN-EC MEd CNeph (C) Toronto General Hospital University Health Network Toronto, Ontario, Canada A moment to remember

More information

Early Estimation of High Peritoneal Permeability Can Predict Poor Prognosis for Technique Survival in Patients on Peritoneal Dialysis

Early Estimation of High Peritoneal Permeability Can Predict Poor Prognosis for Technique Survival in Patients on Peritoneal Dialysis Advances in Peritoneal Dialysis, Vol. 22, 2006 Hidetomo Nakamoto, 1,2 Hirokazu Imai, 2 Hideki Kawanishi, 2 Masahiko Nakamoto, 2 Jun Minakuchi, 2 Shinichi Kumon, 2 Syuichi Watanabe, 2 Yoshhiko Shiohira,

More information

2016 Annual Dialysis Conference Michelle Hofmann RN, BSN, CNN Renal Clinical Educator - Home

2016 Annual Dialysis Conference Michelle Hofmann RN, BSN, CNN Renal Clinical Educator - Home Fluid Management 2016 Annual Dialysis Conference Michelle Hofmann RN, BSN, CNN Renal Clinical Educator - Home Objectives Define euvolemia Determine factors which contribute to fluid imbalance Discuss strategies

More information

Bacterial peritonitis is a common complication of peritoneal

Bacterial peritonitis is a common complication of peritoneal Peritoneal Dialysis International, Vol. 27, pp. 79 85 Printed in Canada. All rights reserved. 0896-8608/07 $3.00 +.00 Copyright 2007 International Society for Peritoneal Dialysis VANCOMYCIN DISPOSITION

More information

Hyperphosphatemia is a strong predictor of overall

Hyperphosphatemia is a strong predictor of overall Peritoneal Phosphate Clearance is Influenced by Peritoneal Dialysis Modality, Independent of Peritoneal Transport Characteristics Sunil V. Badve,* Deborah L. Zimmerman,* Greg A. Knoll, * Kevin D. Burns,*

More information

Adequacy of automated peritoneal dialysis with and without manual daytime exchange: A randomized controlled trial

Adequacy of automated peritoneal dialysis with and without manual daytime exchange: A randomized controlled trial http://www.kidney-international.org & 2006 International Society of Nephrology original article Adequacy of automated peritoneal dialysis with and without manual daytime exchange: A randomized controlled

More information

Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: What, Who, Why, and How? Review and Case Study

Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: What, Who, Why, and How? Review and Case Study Advances in Peritoneal Dialysis, Vol. 33, 2017 Kunal Malhotra, Ramesh Khanna Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: What, Who, Why, and How? Review and Case Study

More information

ad e quate adjective \ˈa-di-kwət\

ad e quate adjective \ˈa-di-kwət\ PD Prescriptions and Adequacy Monitoring: The Basics Fundamentals of Dialysis in Children Seattle, Washington February 27th, 2016 Colin White Steve Alexander Brad Warady Alicia Neu Franz Schaefer Bruce

More information

Original Article ABSTRACT

Original Article ABSTRACT Original Article Peritoneal Equilibration Test (PET) Analysis among Filipino Children on Chronic Peritoneal Dialysis at the National Kidney and Transplant Institute: A Cross-Sectional Study Elmer Kent

More information

PART FOUR. Metabolism and Nutrition

PART FOUR. Metabolism and Nutrition PART FOUR Metabolism and Nutrition Advances in Peritoneal Dialysis, Vol. 22, 2006 Costas Fourtounas, Eirini Savidaki, Marilena Roumelioti, Periklis Dousdampanis, Andreas Hardalias, Pantelitsa Kalliakmani,

More information

What is a PET? Although there are many types of pets, we will be discussing the Peritoneal Equilibration Test

What is a PET? Although there are many types of pets, we will be discussing the Peritoneal Equilibration Test 1 2 3 What is a PET? Although there are many types of pets, we will be discussing the Peritoneal Equilibration Test 4 Background information about the PET 1983 Dr. Twardowski and colleagues began measuring

More information

Tidal peritoneal dialysis: Comparison of different tidal regimens and automated peritoneal dialysis

Tidal peritoneal dialysis: Comparison of different tidal regimens and automated peritoneal dialysis Kidney International, Vol. 57 (2000), 2603 2607 Tidal peritoneal dialysis: Comparison of different tidal regimens and automated peritoneal dialysis PETER H. JUERGENSEN, A. LOLA MURPHY, KATHY A. PHERSON,

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Peritoneal transport and ultrafiltration GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Peritoneal transport and ultrafiltration GUIDELINES Date written: January 2004 Final submission: May 2004 Peritoneal transport and ultrafiltration GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions

More information

PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT QUICK REFERENCE GUIDE

PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT QUICK REFERENCE GUIDE PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT QUICK REFERENCE GUIDE This quick reference guide will help serve as a reference tool for clinicians setting a patient s Peritoneal Dialysis (PD) prescription.

More information

Physiology of Blood Purification: Dialysis & Apheresis. Outline. Solute Removal Mechanisms in RRT

Physiology of Blood Purification: Dialysis & Apheresis. Outline. Solute Removal Mechanisms in RRT Physiology of Blood Purification: Dialysis & Apheresis Jordan M. Symons, MD University of Washington School of Medicine Seattle Children s Hospital Outline Physical principles of mass transfer Hemodialysis

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Monitoring patients on peritoneal dialysis GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Monitoring patients on peritoneal dialysis GUIDELINES Date written: August 2004 Final submission: July 2005 Monitoring patients on peritoneal dialysis GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions

More information

The low ph of conventional peritoneal dialysis (PD) solutions,

The low ph of conventional peritoneal dialysis (PD) solutions, Peritoneal Dialysis International, Vol. 29, pp. 158 162 Printed in Canada. All rights reserved. 0896-8608/09 $3.00 +.00 Copyright 2009 International Society for Peritoneal Dialysis EFFECTS OF IONIZED SODIUM

More information

Free water transport: Clinical implications. Sodium sieving during short very hypertonic dialysis exchanges

Free water transport: Clinical implications. Sodium sieving during short very hypertonic dialysis exchanges Free water transport: Clinical implications Raymond T Krediet, MD,PhD University of Amsterdam Sodium sieving during short very hypertonic dialysis exchanges Nolph KD et al. Ann Int Med 1969;70:931-947

More information

Ana Paula Bernardo. CHP Hospital de Santo António ICBAS/ Universidade do Porto

Ana Paula Bernardo. CHP Hospital de Santo António ICBAS/ Universidade do Porto Ana Paula Bernardo CHP Hospital de Santo António ICBAS/ Universidade do Porto Clinical relevance of hyperphosphatemia Phosphate handling in dialysis patients Phosphate kinetics in PD peritoneal phosphate

More information

Changes in the Peritoneal Equilibration Test in Selected Chronic Peritoneal Dialysis Patients1

Changes in the Peritoneal Equilibration Test in Selected Chronic Peritoneal Dialysis Patients1 hanges in the Peritoneal Equilibration Test in Selected hronic Peritoneal Dialysis Patients1 Wai-Kei Lo, Alessandra Brendolan, Barbara F. Prowant, Harold L. Moore, Ramesh Khanna, Zbylut J. Twardowski,

More information

Determination of Peritoneal Transport Characteristics With 24-Hour Dialysate Collections: Dialysis Adequacy and Transport Test1

Determination of Peritoneal Transport Characteristics With 24-Hour Dialysate Collections: Dialysis Adequacy and Transport Test1 Determination of Peritoneal Transport Characteristics With 24-Hour Dialysate Collections: Dialysis Adequacy and Transport Test1 Michael V. Rocco,2 Jean R. Jordan, and John M. Burkart MV. Rocco, J.M. Burkart,

More information

Peritoneal dialysis in children under two years of age

Peritoneal dialysis in children under two years of age Nephrol Dial Transplant (2008) 23: 1747 1753 doi: 10.1093/ndt/gfn035 Advanced Access publication 28 February 2008 Short Communication Peritoneal dialysis in children under two years of age Hanne Laakkonen

More information

Selection of modalities, prescription, and technical issues in children on peritoneal dialysis

Selection of modalities, prescription, and technical issues in children on peritoneal dialysis Pediatr Nephrol (2009) 24:1453 1464 DOI 10.1007/s00467-008-0848-4 EDUCATIONAL REVIEW Selection of modalities, prescription, and technical issues in children on peritoneal dialysis Enrico Verrina & Valeria

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Mode of dialysis at initiation GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Mode of dialysis at initiation GUIDELINES Date written: September 2004 Final submission: February 2005 Mode of dialysis at initiation GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR CLINICAL CARE (Suggestions

More information

You can sleep while I dialyze

You can sleep while I dialyze You can sleep while I dialyze Nocturnal Peritoneal Dialysis Dr. Suneet Singh Medical Director, PD, VGH Division of Nephrology University of British Columbia Acknowledgements Melissa Etheridge You can sleep

More information

Evaluation and management of nutrition in children

Evaluation and management of nutrition in children Evaluation and management of nutrition in children Date written: May 2004 Final submission: January 2005 Author: Elisabeth Hodson GUIDELINES No recommendations possible based on Level I or II evidence

More information

PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT GUIDE

PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT GUIDE PERITONEAL DIALYSIS PRESCRIPTION MANAGEMENT GUIDE TABLE OF CONTENTS Introduction.... 3 SECTION 1: FUNDAMENTALS OF THE PRESCRIPTION.... 4 Getting Started: Patient Pathway to First Prescription.... 5 Volume

More information

Intermittent peritoneal dialysis (IPD) has occasionally

Intermittent peritoneal dialysis (IPD) has occasionally Peritoneal Dialysis International, Vol. 32, pp. 142 148 doi: 10.3747/pdi.2011.00027 0896-8608/12 $3.00 +.00 Copyright 2012 International Society for Peritoneal Dialysis INTERMITTENT PERITONEAL DIALYSIS:

More information

The Physiology of Peritoneal Dialysis As Related To Drug Removal

The Physiology of Peritoneal Dialysis As Related To Drug Removal The Physiology of Peritoneal Dialysis As Related To Drug Removal Thomas A. Golper, MD, FACP, FASN Vanderbilt University Medical Center Nashville, TN thomas.golper@vanderbilt.edu Clearance By Dialysis Clearance

More information

Maintaining Peritoneal Dialysis Adequacy: The Process of Incremental Prescription

Maintaining Peritoneal Dialysis Adequacy: The Process of Incremental Prescription Advances in Peritoneal Dialysis, Vol. 34, 2018 Susie Q. Lew Maintaining Peritoneal Dialysis Adequacy: The Process of Incremental Prescription Urea kinetics (weekly Kt/V) greater than 1.7 generally define

More information

Vincenzo La Milia 1, Giuseppe Pontoriero 1, Giovambattista Virga 2 and Francesco Locatelli 1

Vincenzo La Milia 1, Giuseppe Pontoriero 1, Giovambattista Virga 2 and Francesco Locatelli 1 Nephrol Dial Transplant (2015) 30: 1741 1746 doi: 10.1093/ndt/gfv275 Advance Access publication 16 July 2015 Ionic conductivity of peritoneal dialysate: a new, easy and fast method of assessing peritoneal

More information

Sequential peritoneal equilibration test: a new method for assessment and modelling of peritoneal transport

Sequential peritoneal equilibration test: a new method for assessment and modelling of peritoneal transport Nephrol Dial Transplant (2013) 28: 447 454 doi: 10.1093/ndt/gfs592 Sequential peritoneal equilibration test: a new method for assessment and modelling of peritoneal transport Magda Galach 1, Stefan Antosiewicz

More information

PD prescribing for all. QUESTION: Which approach? One size fits all or haute couture? (1) or (2)? The patient 18/03/2014.

PD prescribing for all. QUESTION: Which approach? One size fits all or haute couture? (1) or (2)? The patient 18/03/2014. PD prescribing for all Pr Max Dratwa Honorary consultant, Nephrology-Dialysis CHU Brugmann Université Libre de Bruxelles BSN 22 March 2014 QUESTION: Which approach? One size fits all or haute couture?

More information

St George & Sutherland Hospitals PERITONEAL DIALYSIS UNIT RENAL DEPARTMENT Workplace Instruction (Renal_SGH_WPI_097)

St George & Sutherland Hospitals PERITONEAL DIALYSIS UNIT RENAL DEPARTMENT Workplace Instruction (Renal_SGH_WPI_097) PERITONEAL DIALYSIS (PD) PERITONEAL EQUILIBRATION TEST (PET) Cross references NSW Health PD2007_036 - Infection Control Policy SGH-TSH CLIN027 - Aseptic Technique - Competency and Education Requirements

More information

2015 Children's Mercy Hospitals and Clinics. All Rights Reserved.

2015 Children's Mercy Hospitals and Clinics. All Rights Reserved. Growth van Stralen KJ, et al., Kidney Int, 2014 Blood Pressure Management van Stralen KJ, et al., Kidney Int, 2014 Sodium Losses on PD Infants might need higher UF rate per BSA as compared to adults to

More information

Original Article. Key words: Icodextrin, peritoneal dialysis, metabolic effects, ultrafiltration

Original Article. Key words: Icodextrin, peritoneal dialysis, metabolic effects, ultrafiltration Original Article 133 Clinical Experience of One-Year Icodextrin Treatment in Peritoneal Dialysis Patients Chun-Shuo Hsu *, Chien-Yu Su **, Chih-Hung Chang ***, Kao-Tai Hsu **, King-Kwan Lam **, Shang-Chih

More information

Ultrafiltration failure (UFF) is an important cause of

Ultrafiltration failure (UFF) is an important cause of Peritoneal Dialysis International, Vol. 32, pp. 537 544 doi: 10.3747/pdi.2011.00175 0896-8608/12 $3.00 +.00 Copyright 2012 International Society for Peritoneal Dialysis TWO-IN-ONE PROTOCOL: SIMULTANEOUS

More information

What Does Peritoneal Thickness in Peritoneal Dialysis Patients Tell Us?

What Does Peritoneal Thickness in Peritoneal Dialysis Patients Tell Us? Advances in Peritoneal Dialysis, Vol. 23, 2007 Soner Duman, 1 Suha Sureyya Ozbek, 2 Ebru Sevinc Gunay, 1 Devrim Bozkurt, 1 Gulay Asci, 1 Savas Sipahi, 1 Fatih Kirçelli, 1 Muhittin Ertilav, 1 Mehmet Özkahya,

More information

10 Peritoneal dialysis and prescription monitoring

10 Peritoneal dialysis and prescription monitoring 10 Peritoneal dialysis and prescription monitoring B. MORGENSTERN INTRODUCTION Peritoneal dialysis (PO) is the major form of dialysis in use for infants and small children1,2. Data also suggests that pediatric

More information

LLL Session - Nutritional support in renal disease

LLL Session - Nutritional support in renal disease ESPEN Congress Leipzig 2013 LLL Session - Nutritional support in renal disease Peritoneal dialysis D. Teta (CH) Nutrition Support in Patients undergoing Peritoneal Dialysis (PD) Congress ESPEN, Leipzig

More information

Peritoneal transport testing

Peritoneal transport testing THOROUGH CRITICAL APPRAISAL www.sin-italy.org/jnonline www.jnephrol.com Peritoneal transport testing Vincenzo La Milia Nephrology and Dialysis Department, A. Manzoni Hospital, Lecco - Italy Ab s t r a

More information

PERITONEAL DIALYSIS CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006

PERITONEAL DIALYSIS CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006 PERITONEAL DIALYSIS CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2006 PATIENT IDENTIFICATION [Before completing please read instructions at the bottom of this page and on pages 5 and 6] MAKE CORRECTIONS

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Guidelines

The CARI Guidelines Caring for Australians with Renal Impairment. Guidelines 6. Type of peritoneal dialysis Date written: February 2003 Final submission: May 2004 Guidelines No peritoneal dialysis has proven to be superior to the two cuff standard Tenckhoff in the prevention of

More information

Failure to obtain adequate rates of ultrafiltration (UF) is

Failure to obtain adequate rates of ultrafiltration (UF) is Page 1 of 6 Peritoneal Dialysis International Peritoneal Dialysis International, inpress www.pdiconnect.com 0896-8608/16 $3.00 +.00 Copyright 2016 International Society for Peritoneal Dialysis ANALYSIS

More information

Peritoneal dialysis adequacy: A model to assess feasibility with various modalities

Peritoneal dialysis adequacy: A model to assess feasibility with various modalities Kidney International, Vol. 55 (1999), pp. 2493 2501 Peritoneal dialysis adequacy: A model to assess feasibility with various modalities JOSE A. DIAZ-BUXO, FRANK A. GOTCH, TOM I. FOLDEN, SHELDEN ROSENBLUM,

More information

Analysis of fluid transport pathways and their determinants in peritoneal dialysis patients with ultrafiltration failure

Analysis of fluid transport pathways and their determinants in peritoneal dialysis patients with ultrafiltration failure original article http://www.kidney-international.org & 26 International Society of Nephrology Analysis of fluid transport pathways and their determinants in peritoneal dialysis patients with ultrafiltration

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Level of renal function at which to initiate dialysis GUIDELINES

The CARI Guidelines Caring for Australians with Renal Impairment. Level of renal function at which to initiate dialysis GUIDELINES Level of renal function at which to initiate dialysis Date written: September 2004 Final submission: February 2005 GUIDELINES No recommendations possible based on Level I or II evidence SUGGESTIONS FOR

More information

USRDS UNITED STATES RENAL DATA SYSTEM

USRDS UNITED STATES RENAL DATA SYSTEM USRDS UNITED STATES RENAL DATA SYSTEM Chapter 8: Pediatric ESRD 1,462 children in the United States began end-stage renal disease (ESRD) care in 2013. 9,921 children were being treated for ESRD on December

More information

Glucose sparing in peritoneal dialysis: Implications and metrics

Glucose sparing in peritoneal dialysis: Implications and metrics http://www.kidney-international.org & 26 International Society of Nephrology Glucose sparing in peritoneal dialysis: Implications and metrics C Holmes 1 and S Mujais 1 1 Renal Division, Baxter Healthcare

More information

Peritoneal Dialysis International, Vol. 16, pp /96$300+00

Peritoneal Dialysis International, Vol. 16, pp /96$300+00 Peritoneal Dialysis International, Vol. 16, pp 302-306 0896-8608/96$300+00 Printed in Canada All rights reserved Copyright 1996 International Society for Peritoneal Dialysis CONTINUOUS PERITONEAL DIAL

More information

How to evaluate the peritoneal membrane?

How to evaluate the peritoneal membrane? How to evaluate the peritoneal membrane? B. Bammens Brussels, May 12 2016 BELGIUM How to evaluate a hemodialyzer? How to evaluate a hemodialyzer? How to evaluate a hemodialyzer? From: Robert W. Schrier

More information

De Novo Hypokalemia in Incident Peritoneal Dialysis

De Novo Hypokalemia in Incident Peritoneal Dialysis Original investigation 73 1) De Novo Hypokalemia in Incident Peritoneal Dialysis Patients: A 1-Year Observational Study Ji Yong Jung, M.D., Jae Hyun Chang, M.D., Hyun Hee Lee, M.D., Wookyung Chung, M.D.

More information

Unrestricted pore area (A 0 / x) is a better indicator of peritoneal membrane function than PET

Unrestricted pore area (A 0 / x) is a better indicator of peritoneal membrane function than PET Kidney International, Vol. 58 (2000), pp. 1773 1779 Unrestricted pore area (A 0 / x) is a better indicator of peritoneal membrane function than PET EVA JOHNSSON, ANN-CATHRINE JOHANSSON, BRITT-INGER ANDREASSON,

More information

PART ONE. Peritoneal Kinetics and Anatomy

PART ONE. Peritoneal Kinetics and Anatomy PART ONE Peritoneal Kinetics and Anatomy Advances in Peritoneal Dialysis, Vol. 20, 2004 Ewa E. Kaczmarek, Alicja E. Grzegorzewska Two Years on Continuous Ambulatory Peritoneal Dialysis Does It Change Peritoneal

More information

The role of automated peritoneal dialysis (APD) in an integrated dialysis programme

The role of automated peritoneal dialysis (APD) in an integrated dialysis programme The role of automated peritoneal dialysis (APD) in an integrated dialysis programme Paul Williams*^, Linda Cartmel* and Jane Hollis^ *CAPD Unit, Ipswich Hospital, Ipswich, UK; 1CAPD Unit, Addenbrooke's

More information

Geriatric Nutritional Risk Index, home hemodialysis outcomes 131

Geriatric Nutritional Risk Index, home hemodialysis outcomes 131 Subject Index Aksys PHD system 113 Anemia, home outcomes 111, 172, 173 Automated peritoneal dialysis dialysis comparison 17, 18 selection factors 18, 19 telemedicine system 19 21 Blood pressure -peritoneal

More information

6. Type of peritoneal dialysis catheter

6. Type of peritoneal dialysis catheter Blackwell Science, LtdOxford, UKNEPNephrology1320-53582004 Asian Pacific Society of NephrologyOctober 20049S3S59S64MiscType of peritoneal dialysis The CARI Guidelines NEPHROLOGY 2004; 9, S59 S64 Date written:

More information

Acid-base profile in patients on PD

Acid-base profile in patients on PD Kidney International, Vol. 6, Supplement 88 (23), pp. S26 S36 Acid-base profile in patients on PD SALIM MUJAIS Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois Acid-base profile in patients

More information

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients

The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients NDT Plus (2008) 1 [Suppl 4]: iv41 iv45 doi: 10.1093/ndtplus/sfn123 The relationship between effluent potassium due to cellular release, free water transport and CA125 in peritoneal dialysis patients Annemieke

More information

Selected Clinical Calculations Chapter 10. Heparin-Dosing calculations

Selected Clinical Calculations Chapter 10. Heparin-Dosing calculations Selected Clinical Calculations Chapter 10 Heparin-Dosing calculations Heparin is a heterogeneous group of muco-polysaccharides that have anticoagulant properties (slows clotting time). Heparin salt, as

More information

Presternal Catheter Design An Opportunity to Capitalize on Catheter Immobilization

Presternal Catheter Design An Opportunity to Capitalize on Catheter Immobilization Advances in Peritoneal Dialysis, Vol. 26, 2010 Dale G. Zimmerman Presternal Catheter Design An Opportunity to Capitalize on Catheter Immobilization Effective immobilization of the peritoneal catheter has

More information

Phosphate Clearance in Peritoneal Dialysis: Automated PD Compared with Continuous Ambulatory PD

Phosphate Clearance in Peritoneal Dialysis: Automated PD Compared with Continuous Ambulatory PD Advances in Peritoneal Dialysis, Vol. 28, 2012 Dixie-Ann Sawin, Rainer Himmele, Jose A. Diaz Buxo Phosphate Clearance in Peritoneal Dialysis: Automated PD Compared with Continuous Ambulatory PD Although

More information

Title:Hyperphosphatemia as an Independent Risk Factor of Coronary Artery Calcification Progression in Peritoneal Dialysis Patients

Title:Hyperphosphatemia as an Independent Risk Factor of Coronary Artery Calcification Progression in Peritoneal Dialysis Patients Author's response to reviews Title:Hyperphosphatemia as an Independent Risk Factor of Coronary Artery Calcification Progression in Peritoneal Dialysis Patients Authors: Da Shang (sdshangda@163.com) Qionghong

More information

PART SIX. Pediatrics

PART SIX. Pediatrics PART SIX Pediatrics Advances in Peritoneal Dialysis, Vol. 19, 2003 Michel Fischbach, 1 Börje Haraldsson, 2 Pauline Helms, 1 Stéphanie Danner, 1 Vincent Laugel, 1 Joëlle Terzic 1 The Peritoneal Membrane:

More information

Intravenous Iron Does Not Affect the Rate of Decline of Residual Renal Function in Patients on Peritoneal Dialysis

Intravenous Iron Does Not Affect the Rate of Decline of Residual Renal Function in Patients on Peritoneal Dialysis Advances in Peritoneal Dialysis, Vol. 22, 2006 Hemal Shah, Ashutosh Shukla, Abirami Krishnan, Theodore Pliakogiannis, Mufazzal Ahmad, Joanne M. Bargman, Dimitrios G. Oreopoulos Intravenous Iron Does Not

More information

Hyaluronan Influence on Diffusive Permeability of the Peritoneum In Vitro

Hyaluronan Influence on Diffusive Permeability of the Peritoneum In Vitro Advances in Peritoneal Dialysis, Vol. 24, 2008 Teresa Grzelak, Beata Szary, Krystyna Czyzewska Hyaluronan Influence on Diffusive Permeability of the Peritoneum In Vitro Hyaluronan (HA), an essential component

More information

No increase in small-solute transport in peritoneal dialysis patients treated without hypertonic glucose for fifty-four months

No increase in small-solute transport in peritoneal dialysis patients treated without hypertonic glucose for fifty-four months Pagniez et al. BMC Nephrology (2017) 18:278 DOI 10.1186/s12882-017-0690-7 RESEARCH ARTICLE No increase in small-solute transport in peritoneal dialysis patients treated without hypertonic glucose for fifty-four

More information

Ultrafiltration and solute kinetics using low sodium peritoneal dialysate

Ultrafiltration and solute kinetics using low sodium peritoneal dialysate Kidney International, Vol. 48 (1995), pp. 1959 1966 Ultrafiltration and solute kinetics using low sodium peritoneal dialysate JOHN K. LEYPOLDT, DAVID I. CHARNEY, ALFRED K. CHEUNG, CYNTHIA L. NAPRESTEK,

More information

Strategies to Preserve the Peritoneal Membrane. Reusz GS Ist Dept of Pediatrics Semmelweis University, Budapest

Strategies to Preserve the Peritoneal Membrane. Reusz GS Ist Dept of Pediatrics Semmelweis University, Budapest Strategies to Preserve the Peritoneal Membrane Reusz GS Ist Dept of Pediatrics Semmelweis University, Budapest Outline 1. Structure of the peritoneal membrane 2. Mechanisms of peritoneal injury 3. Signs

More information

Brief communication (Original)

Brief communication (Original) Asian Biomedicine Vol. 8 No. 1 February 2014; 67-73 DOI: 10.5372/1905-7415.0801.263 Brief communication (Original) Long-term clinical effects of treatment by daytime ambulatory peritoneal dialysis with

More information

Peritoneal Dialysis International, Vol. 17, pp /97 $ THE PERITONEAL CAVITY OF RATS

Peritoneal Dialysis International, Vol. 17, pp /97 $ THE PERITONEAL CAVITY OF RATS Peritoneal Dialysis International, Vol. 17, pp 179-185 0896-8608/97 $300 + 00 Printed in Canada All rights reserved Copyright 1997 International Soeiety for Peritoneal Dialysis CHRONIC ADMINISTRATION OF

More information

Proceedings of the ISPD 2006 The 11th Congress of the ISPD /07 $ MAXIMIZING THE SUCCESS OF PERITONEAL DIALYSIS IN HIGH TRANSPORTERS

Proceedings of the ISPD 2006 The 11th Congress of the ISPD /07 $ MAXIMIZING THE SUCCESS OF PERITONEAL DIALYSIS IN HIGH TRANSPORTERS Proceedings of the ISPD 2006 The 11th Congress of the ISPD 0896-8608/07 $3.00 +.00 August 25 29, 2006, Hong Kong Copyright 2007 International Society for Peritoneal Dialysis Peritoneal Dialysis International,

More information

Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations

Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations NDT Advance Access published November 9, 2005 Nephrol Dial Transplant (2005) 1 of 8 doi:10.1093/ndt/gfi248 Original Article Effect of previously failed kidney transplantation on peritoneal dialysis outcomes

More information

Chapter 8: ESRD Among Children, Adolescents, and Young Adults

Chapter 8: ESRD Among Children, Adolescents, and Young Adults Chapter 8: ESRD Among Children, Adolescents, and Young Adults The number of children beginning end-stage renal disease (ESRD) care decreased by 6% in 2014, totaling 1,398 (Figure 8.1.a). 9,721 children

More information

Volume Management 2/25/2017. Disclosures statement: Objectives. To discuss evaluation of hypervolemia in peritoneal dialysis patients

Volume Management 2/25/2017. Disclosures statement: Objectives. To discuss evaluation of hypervolemia in peritoneal dialysis patients Volume Management Sagar Nigwekar MD, MMSc Massachusetts General Hospital E-mail: snigwekar@mgh.harvard.edu March 14, 2017 Disclosures statement: Consultant: Allena, Becker Professional Education Grant

More information

Malnutrition and inflammation in peritoneal dialysis patients

Malnutrition and inflammation in peritoneal dialysis patients Kidney International, Vol. 64, Supplement 87 (2003), pp. S87 S91 Malnutrition and inflammation in peritoneal dialysis patients PAUL A. FEIN, NEAL MITTMAN, RAJDEEP GADH, JYOTIPRAKAS CHATTOPADHYAY, DANIEL

More information

Validity of the use of Schwartz formula against creatinine clearance in the assessment of renal functions in children

Validity of the use of Schwartz formula against creatinine clearance in the assessment of renal functions in children Validity of the use of Schwartz formula against creatinine clearance in the assessment of renal functions in children *H W Dilanthi 1, G A M Kularatnam 1, S Jayasena 1, E Jasinge 1, D B D L Samaranayake

More information

The greatest benefit of peritoneal dialysis (PD) is the

The greatest benefit of peritoneal dialysis (PD) is the Peritoneal Dialysis International, Vol. 26, pp. 150 154 Printed in Canada. All rights reserved. 0896-8608/06 $3.00 +.00 Copyright 2006 International Society for Peritoneal Dialysis COMBINATION THERAPY

More information

Chapter IX. Pediatric End Stage Renal Disease. Incidence of Reported Pediatric ESRD

Chapter IX. Pediatric End Stage Renal Disease. Incidence of Reported Pediatric ESRD Annual Data Report Chapter IX T his chapter examines the incidence, prevalence, modalities of treatment, and survival outcomes specific to the national pediatric ESRD population. Children with advanced

More information

Predicting Clinical Outcomes in Peritoneal Dialysis Patients Using Small Solute Modeling

Predicting Clinical Outcomes in Peritoneal Dialysis Patients Using Small Solute Modeling 46 Annals of Clinical & Laboratory Science, vol. 35, no. 1, 2005 Predicting Clinical Outcomes in Peritoneal Dialysis Patients Using Small Solute Modeling Justin Westhuyzen, 1 Karen Mills, 2 and Helen Healy

More information

Chronic renal failure and growth

Chronic renal failure and growth Archives of Disease in Childhood, 199, 6, 573-577 Chronic renal failure and growth L REES, S P A RIGDEN, AND G M WARD Evelina Children's Hospital, United Medical and Dental Schools, Guy's Hospital, London

More information

Peritoneal Dialysis Adequacy: Not Just Small- Solute Clearance

Peritoneal Dialysis Adequacy: Not Just Small- Solute Clearance Advances in Peritoneal Dialysis, Vol. 24, 2008 Rajesh Yalavarthy, Isaac Teitelbaum Peritoneal Dialysis Adequacy: Not Just Small- Solute Clearance Two indices of small-solute clearance, Kt/V urea and creatinine

More information

Automated peritoneal dialysis (APD) has, in recent

Automated peritoneal dialysis (APD) has, in recent VIIth International Course on Peritoneal Dialysis May 23 26, 2000, Vicenza, Italy Peritoneal Dialysis International, Vol. 20, Suppl. 2 0896-8608/00 $3.00 +.00 Copyright 2000 International Society for Peritoneal

More information

5. Indications for the use of urokinase in peritoneal dialysis associated peritonitis

5. Indications for the use of urokinase in peritoneal dialysis associated peritonitis 5. Indications for the use of urokinase in peritoneal dialysis associated peritonitis Date written: February 2003 Final submission: July 2004 Guidelines (Include recommendations based on level I or II

More information

Smart APD prescription. Prof. Wai Kei Lo Tung Wah Hospital The University of Hong Kong

Smart APD prescription. Prof. Wai Kei Lo Tung Wah Hospital The University of Hong Kong Smart APD prescription Prof. Wai Kei Lo Tung Wah Hospital The University of Hong Kong Costing Comparison of Different Modes of RRT in Hong Kong in 2011 (Per Year) HK$300,000 HK$250,000 HK$200,000 HK$150,000

More information

The Effect of Residual Renal Function at the Initiation of Dialysis on Patient Survival

The Effect of Residual Renal Function at the Initiation of Dialysis on Patient Survival ORIGINAL ARTICLE DOI: 10.3904/kjim.2009.24.1.55 The Effect of Residual Renal Function at the Initiation of Dialysis on Patient Survival Seoung Gu Kim 1 and Nam Ho Kim 2 Department of Internal Medicine,

More information

The definition of peritoneal dialysis (PD) adequacy has

The definition of peritoneal dialysis (PD) adequacy has Peritoneal Dialysis International, Vol. 29, pp. 465 471 Printed in Canada. All rights reserved. 0896-8608/09 $3.00 +.00 Copyright 2009 International Society for Peritoneal Dialysis DIALYTIC PHOSPHATE REMOVAL:

More information

Renal Self Learning Package INTRODUCTION TO PERITONEAL DIALYSIS

Renal Self Learning Package INTRODUCTION TO PERITONEAL DIALYSIS Renal Self Learning Package INTRODUCTION TO PERITONEAL DIALYSIS St George Hospital Renal Department, reviewed 2017 St George Hospital Renal Department RENAL SELF LEARNING PACKAGE INTRODUCTION TO PERITONEAL

More information

Drug Use in Dialysis

Drug Use in Dialysis (Last Updated: 08/22/2018) Created by: Socco, Samantha Drug Use in Dialysis Drambarean, B. (2017). Drug Use in Dialysis. Lecture presented at PHAR 503 Lecture in UIC College of Pharmacy, Chicago. DIALYSIS

More information

Managing Acid Base and Electrolyte Disturbances with RRT

Managing Acid Base and Electrolyte Disturbances with RRT Managing Acid Base and Electrolyte Disturbances with RRT John R Prowle MA MSc MD MRCP FFICM Consultant in Intensive Care & Renal Medicine RRT for Regulation of Acid-base and Electrolyte Acid base load

More information