CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) AND CHRONIC CYCLING PERITONEAL DIALYSIS (CCPD) IN CHILDREN

Transcription

1 CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) AND CHRONIC CYCLING PERITONEAL DIALYSIS (CCPD) IN CHILDREN

2 Topics in Renal Medicine Vittorio E Andreucci, Series Editor 1. VE Andreucci, The Kidney In Pregnancy. ISBN AR Clarkson, IgA Nephropathy. ISBN V Camhi, Short Dialysis. ISBN

3 CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) AND CHRONIC CYCLING PERITONEAL DIAL YSIS (CCPD) IN CHILDREN edited by RICHARD N FINE, M.D. UCLA School of Medicine MARTINUS NIJHOFF PUBLISHING A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP 80STON DORDRECHT LANCASTER

4 Copyright 1987 by Martinus NijhoffPublishing, Boston Softcover reprint of the hardcover I st edition 1987 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publishers. Martinus NijhoffPublishers, 101 Philip Drive, Assinippi Park, Norwell, MA Distributors for the United States and Canada: Kluwer Academic Publishers, 101 Philip Drive, Assinippi Park, Norwell, MA for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited, Falcon House, Queen Square, Lancaster LAI IRN, UK for all other countries: Kluwer Academic Publishers Group, Distribution Centre, P. O. Box 322, 3300 AH Dordrecht, The Netherlands Library of Congress Cataloging-in-Publication Data Chronic ambulatory peritoneal dialysis (CAPD) and chronic cycling peritoneal dialysis (CCPD) in children. (Topics in renal medicine) Includes index. 1. Continuous ambulatory peritoneal dialysis in children. 2. Continuous cycling peritoneal dialysis in children. I. Fine, Richard N. II. Series. [DNLM: 1. Peritoneal Dialysis-in infancy & childhood. 2. Peritoneal Dialysis, Continuous Ambulatory-in infancy & childhood. Wj 378 C5565] Rj470.5.P47C ' ISBN-l3: e-isbn-13: DOl: /

5 To Shawney: "because I never had to say I'm sorry"

6 TABLE OF CONTENTS Contributing Authors x Preface Xlll 1. The use of peritoneal dialysis in Europe for treatment of children with end stage renal disease-edt A registry data 1 GIANFRANCORIZZONI, M.D., MICHELBROYER, M.D., SABRI CHALLAH, M.D., NEVILLE H SELWOOD, M.D. 2. Demographic data on the use ofcapd/ccpd as a primary dialytic therapy in children in the United States 13 ANTONIA C NOVELLO, M.D., M.P.H., ANNE S LINDBLAD, M.S., JOEL WNOVAK, M.S., KARL D NOLPH, M.D. 3. Pediatric CAPD in developing countries 21 JOSE GRONBERG, M.D., MARIA CRISTINA VEROCAY, M.D., ALICIA AREA, R.N. 4. Developmental aspects of peritoneal dialysis kinetics 33 ALAN B GRUSKIN, M.D., GARY R LERNER, M.D., LARRY E FLEISCHMANN, M.D. 5. Peritoneal dialysis kinetics in children 47 BRUCE Z MORGENSTERN, M.D., HJORGE BALUARTE, M.D. 6. Kinetics ofccpd in children 63 HEINZ E LEICHTER, M.D. vii

7 viii Table of Contents 7. CAPD in infants 77 EDWARD C KOHAUT, M.D. 8. Technical aspects ofcapd/ccpd 87 LAWRENCEMOPAS, M.D. 9. Peritoneal catheter: technique, logevity, complications 111 ERIC W FONKALSRUD, M.D. 10. Continuous ambulatory peritoneal dialysis in children; biochemical control of uremia, anemia, hypertension, lipid metabolism, glucose tolerance, and endocrine abnormalities 123 ROBERT S FENNELL III, M.D., ABDOLLAH IRAVANI, M.D., GEORGE A RICHARD, M.D. 11. The role of the nurse in CAPD/CCPD training 153 MARCIA A WILSON, R.N. 12. Complications ofcapd/ccpd in pediatric patients 179 ANDREW S BREM, M.D. 13. Peritonitis in infants and children on CAPD/CCPD 189 GARY M LUM, M.D. 14. Loss of ultrafiltration and sclerosing encapsulating peritonitis in children undergoing CAPD/CCPD 201 PATRICKNIAUDET, M.D. 15. Long-term function of the peritoneal membrane 221 TASSILO VON LILIEN, M.D. 16. Nutritional recommendations for children treated with CAPDI CCPD 235 ISIDRO B SALUSKY, M.D. 17. The role of the dietitian in the management of children undergoing CAPDI CCPD 245 PAULINE NELSON, R.D. 18. Supplemental (NG) feedings of infants undergoing continuous peritoneal dial ysis 263 SUSAN B CONLEY, M.D. 19. Protein losses during CAPD in children: the role of dialysates containing amino acids 271 RHONAMHANNING, PH.D., STANLEY HZLOTKIN, M.D., J WILLIAMSON BALFE, M.D. 20. Control of renal bone disease by high-dose calcitriol and the use of calcium carbonate as a phosphate-binding agent in children on CAPDI CCPD 279 ISIDRO B SALUSKY, M.D. 21. Growth in children on CAPD 289 EDWARD C KOHAUT, M.D., F BRYSON WALDO, M.D. 22. Comparison ofcapd and hemodialysis in children 297 DONALD E POTTER, M.D.

8 ix 23. Comparison ofcapd and CCPD in children 307 RONALD J HOGG, M.D. 24. Transplantation in children undergoing CAPD and CCPD 317 HEINZ E LEICHTER, M.D. 25. Promoting psychosocial adaptation to continuous ambulatory peritoneal dialysis/continuous cylcing peritoneal Dialysis in Children and Adolescents 325 PAUL R MUNFORD, PH.D. Index 337

9 CONTRIBUTING AUTHORS ALICIA AREA, R.N. Auxiliary Nursing CAPDUnit Hospital-Sanatorio Espanol Montevideo, Uruguay J WILLIAMSON BALFE, M.D. Associate Professor of Pediatrics Division of Nephrology, Rm C The Hospital for Sick Children 555 University Avenue Toronto, Ontario, Canada M5G lx8 HJORGE BALUARTE, M.D. Professor of Pediatrics Temple University School of Medicine Chief, Section of Nephrology St. Christopher's Hospital for Children 5th & Lehigh Avenue Philadelphia, Pennsylvania ANDREW S BREM, M.D. Assistant Professor of Pediatrics Brown University Program in Medicine Division of Pediatric Nephrology Rhode Island Hospital SWP Eddy Street Providence, R MICHEL BROYER, M.D. Hospital Necker Enfants Malades Paris, France SABRI CHALLAH, M.D. St. Thomas' Hospital London, United Kingdom SUSAN B CONLEY, M.D. Associate Professor of Pediatrics Chief, Pediatric Nephrology The University of Texas Medical School at Houston 6431 Fannin Street Houston, Texas ROBERT S FENNELL III, M.D. Professor of Pediatrics Department of Pediatrics BoxJ-296 University of Florida College of Medicine Gainesville, Florida LARRY E FLEISCHMANN, M.D. Professor of Pediatrics Wayne State University of Medicine Chief of Nephrology Director of Medical Education Children's Hospital of Michigan x

10 xi 3901 Beaubien Blvd. Detroit, Michigan ERIC FONKALSRUD, M.D. Professor and Chief, Pediatric Surgery Department of Surgery UCLA School of Medicine Center for the Health Science Los Angeles, California JOSE GRUNBERG, M.D. Director, Pediatric Nephrology Unit Hospital Pereira Rossell Cas ilia de Correo 1138 Montevideo, Uruguay ALAN B GRUSKIN, M.D. Professor and Chairman Department of Pediatrics.. Wayne State University School of MedIC me Pediatrician-in-Chief Children's Hospital of Michigan 3901 Beaubien Blvd. Detroit, Michigan RHONA M HANNING, Ph.D. McMaster University Hamilton, Ontario, Canada RONALD HOGG, M.D. Chief of Pediatrics Baylor University Medical Center Truett Gaston Avenue Dallas, Texas ABDOLLAH IRAVANI, M.D. Associate Professor of Pediatrics Department of Pediatrics BoxJ-296 University of Florida College of Medicine Gainesville, Florida EDWARD C KOHAUT, M.D. Professor of Pediatrics Director, Pediatric Dialysis and Transplant University of Alabama at Birmingham th Avenue South Birmingham, Alabama GARY R LERNER, M.D. Assistant Professor Department of Pediatrics Wayne State University School of Medicine Member, Division of Nephrology Children's Hospital of Michigan 3901 Beaubien Blvd. Detroit, Michigan HEINZ E LEICHTER, M.D. Assistant Professor of Pediatrics Medical College of Wisconsin Division of Pediatric Nephrology Children's Hospital of Wisconsin 1700 W. Wisconsin Avenue Milwaukee, Wisconsin ANNE S LINDBLAD, M.S. Data Coordinating Center National CAPD Registry The Emmes Corporation Potomac, Maryland GARY LUM, M.D. Associate Professor of Pediatrics and Medicine University of Colorado Health Science Center 4200 E. 9th Avenue Campus Box C282 Denver, Colorado BRUCE Z MORGENSTERN, M.D. Chief, Section on Pediatric Nephrology USAF Medical Center Keesler Keesler A.F.B., Mississippi PAUL R MUNFORD, Ph.D. Associate Professor Department of Psychiatry and Biobehavioral Sciences C8-699 NPI UCLA School of Medicine Los Angeles, California PAULINE NELSON, R.D. Department of Pediatrics Division of Pediatric Nephrology UCLA Center for the Health Sciences Le Conte Boulevard Los Angeles, California PATRICK NIAUDET, M.D. Service de Nephrologie Pediatrique Department de Pediatrie Hopital Necker-Enfants Malades 149 rue de Sevres Paris Cedex 15 KARL D NOLPH, M.D. Professor of Medicine Chief, Department of Nephrology The University of Missouri Columbia, Missouri JOEL W NOVAK, M.S. Data Coordinating Center National CAPD Registry The Emmes Corporation Potomac, Maryland 20854

11 xii Contributing Authors ANTONIA C NOVELLO, M.D., M.P.H. Deputy Director National Institute of Child Health and Human Development National Institutes of Health Bethesda, Maryland LAWRENCE M OPAS, M.D. Associate Professor of Clinical Pediatrics University of Southern California Head, Division of Pediatric Nephrology Los Angeles County-University of Southern California Medical Center Staff Physician, Childrens Hospital of Los Angeles DONALD E POTTER, M.D. Associate Clinical Professor of Pediatrics University of California, San Francisco San Francisco, California GEORGE A RICHARD, M.D. Department of Pediatrics BoxJ-296 University of Florida College of Medicine Gainesville, Florida GIANFRANCO RIZZONI, M.D. Department of Paediatrics University of Pad ova Italy NEVILLE H SELWOOD, M.D. UK Transplant Service Bristol, United Kingdom ISIDRO B SALUSKY, M.D. Assistant Professor of Pediatrics Division of Pediatric Nephrology Director, Pediatric Dialysis Program UCLA Center for the Health Sciences Los Angeles, California MARIACRISTINAVEROCAY, M.D. CAPDUnit Hospital-Sanatorio Espanol Montevideo, Uruguay TASSILO VON LILLIEN, M.D. Universitaets-Kinderklinik Josef-Stelzmann-Strasse D-5000 Koeln 41 West Germany F BRYSON WALDO, M.D. Assistant Professor of Pediatrics University of Alabama at Birmingham th Avenue South Birmingham, Alabama MARCIA WILSON,R.N. Pediatric Dialysis Unit UCLA Center for the Health Sciences Los Angeles, California STANLEY H ZLOTKIN, M.D., Ph.D. Assistant Professor of Pediatrics Division of Clinical Nutrition Room 8511 The Hospital for Sick Children 555 University Avenue Toronto. Ontario. Canada M5G1X8

12 PREFACE During the past decade, there has been a renaissance of interest in the use of peritoneal dialysis as a primary dialytic modality for the treatment of children with end stage renal disease (ESRD). The development of the technique of continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) has markedly changed the approach to children requiring dialytic therapy. The availability of these techniques has facilitated prolonged dialysis in infants and has for the first time given pediatric nephrologists in many areas of the world an opportunity to consider dialysis in children afflicted with ESRD. I have enlisted the collaboration of colleagues from Europe, South America, Canada, and the United States in compiling this multidisciplinary text, which hopefully contains the most up-to-date, comprehensive information regarding the use of CAPD/CCPD in children. It is my hope that every nephrologist (pediatric and adult); nephrology nurse (pediatric and adult); nephrology technician, or allied health professional dealing with children who require these therapeutic modalities will be able to resolve immediately any confounding clinical or technical issues that arise by using the information contained in this text. Demographic data on the use of CAPD/CCPD in children in Europe is provided from the EDTA Registry and in the United States from the National Peritoneal Dialysis Registry. The particular problems encountered in the use xiii

13 xiv Preface of CAPD in children in developing countries is detailed by Dr. Grunberg and his colleagues in Uruguay. In infants, the kinetics of peritoneal dialysis evolve during the first year of life. Dr. Gruskin and his colleagues from Detroit detail this evolution. Similarly, Drs. Morgenstern and Baluarte from Philadelphia detail the kinetics of peritoneal dialysis in children, and Dr. Leichter from Milwaukee for the first time delineates the kinetics of CCPD in children. The use ofcapd/ccpd has particular advantages in the infant. Dr. Kohaut from Birmingham describes his extensive experience with this age group. Dr. Conley from Houston defines the importance of nutrition in infants undergoing peritoneal dialysis and relates her criteria for the use of supplemental nasogastric feedings to assure adequate nutritional intake. The technical aspects of CAPD/CCPD are extensively described by Dr. Opas from Los Angeles; Dr. Fonkalsrud details the experience from UCLA with peritoneal catheters. Because CAPD/CCPD are home dialysis techniques, the nurse has a pivotal role in training and interacting with the child and family undergoing CAPD/CCPD. Ms. Wilson from UCLA describes in detail the methodology required to train children and their families to safely undertake the procedure at home. Dr. Fennell and colleagues from Gainesville provide information regarding the efficacy of CAPD I CCPD in reversing the clinical consequences of uremia. Unfortunately, clinical and technical complications occur with CAPD/CCPD, and these are detailed by Dr. Brem from Providence. The most significant complication of CAPD/CCPD is peritonitis. Dr. Lum from Denver describes the etiology and treatment of this complication. A major concern is the effect of the continuous use of the peritoneal membrane on long-term function. Dr. Niaudet from Paris describes the fortunately infrequent complication leading to abnormal membrane function of sclerosing peritonitis. Dr. von Lilien from Cologne details the experience at UCLA with the long-term function of the peritoneal membrane in children undergoing CAPD/CCPD. Adequate nutrition is mandatory in order to achieve an optimal clinical outcome in children undergoing CAPD/CCPD. Dr. Salusky from UCLA defines the appropriate nutritional requirements for children undergoing CAPDI CCPD. Ms. Nelson, also from UCLA, extensively describes the practical approach to achieving the nutritional goals. Because dialysate protein losses can adversely affect the nutritional status of the child undergoing CAPDI CCPD, Dr. Hanning and colleagues from Toronto detail a novel approach to improve protein intake. Renal osteodystrophy has the potential to progress despite the initiation of CAPD/CCPD in children. Dr. Salusky demonstrates the efficacy of the use of high-dose calcitriol in preventing the progression of bone disease as well as the use of calcium carbonate to avoid aluminium toxicity. One of the onerous facets of chronic renal failure in children is growth re-

14 xv tardation. Drs. Kohaut and Waldo relate their experience with growth in children undergoing CAPO. Is hemodialysis better than CAPO? Is CAPO better than CCPD? Dr. Potter from San Francisco and Dr. Hogg from Dallas attempt to answer these questions. Similarly, can a child undergoing CAPD/CCPD receive a renal transplant? Dr. Leichter provides adequate information to answer this question affirmatively. Lastly, all forms of ESRD care are accompanied by significant psychosocial problems. Dr. Munford from UCLA details an approach to enhance the adaptation of children to these therapeutic modalities. It is my hope that the information contained in this text will prove helpful to those charged with the difficult task of caring for children undergoing CAPO I CCPD. If one child suffers less or if one child smiles more because of the information contained here, the efforts of those involved will have been worthwhile. Richard N Fine, M.D. Professor of Pediatrics Vice-Chairman for Clinical Affairs Head, Division of Pediatric Nephrology UCLA Center for the Health Sciences

15 CHRONIC AMBULATORY PERITONEAL DIALYSIS (CAPD) AND CHRONIC CYCLING PERITONEAL DIALYSIS (CCPD) IN CHILDREN