Ped pd ismailia

1. Pediatric Peritoneal Dialysis
Dr. Osama El-ShahatDr. Osama El-Shahat
Consultant Nephrologist
Head of Nephrology Department
New Mansoura General Hospital (international)
ISN Educational Ambassador

2. 11stst
steps towards peritonealsteps towards peritoneal
dialysis.dialysis.
Ancient Egypt were probably the first people to get a look at the peritoneum
The word preitoneum refers to the Greek word “peritononionperitononion” and means to stretch.

3. PD … the modality first used for thePD … the modality first used for the
treatment of KItreatment of KI

4. Managing New Patient with ESRD
“Complementary Not Competitive” Coles 1998
“The right modality at the right time. PeterBlake, MD, John Burkart,
Early referral of patient
With CKD to renal center
Pre-emptive
Transplantation
PD as first option if medically suitable
Allowing for patient chioce
Patient education
program
HD Transplant
PDPD

5. Why to start with PD?
Preservation of RRF
Higher Hb concentration
Less risk of acquiring blood borne infections e.g. HCV
Better quality of life
Travel , employment
It allows expansion with limited resources
Lower staff / patient ratio
saves vascular access
 preferred for children (APD)

6.  Peritoneal dialysis (PD) is in general the preferred treatment
modality for pediatric patients to bridge the time until
transplantation.
 It is easier to perform, less invasive than extracorporeal
treatments and does not require anticoagulation. However,
what counts most for the child and the family is that PD can
be carried out at home.
 PD is more compatible with a “normal” lifestyle and allows a
better psychosocial integration of the little patient.

7. Patient selection
PositivePositive NegativeNegative
Selecting RRT modalities is influenced by a number of
considerations such as
 Patient Preference .
 Availability And Convenience.
 Underlying Medical Problems and Comorbid Conditions.
 Socioeconomic and Dialysis Center Factors.
 The Patient's Home Situation
 Medical staff Training.

9. PD-PD- RequirementsRequirements
PD .PD .catheters PDPD. solution

10. Technique &TypesTechnique &Types of Chronic PDof Chronic PD
1.1. Fill PhaseFill Phase (<15 minutes)*
Disconnect
2.2. Dwell phaseDwell phase (4-8 hours)
3.3.Drain phaseDrain phase (<20 minutes)
 CAPD (ContinuousContinuous AmbulatoryAmbulatory PeritonealPeritoneal DialysisDialysis)
 APD (Automated Peritoneal DialysisAutomated Peritoneal Dialysis)
 CCPD (Continuous Cycling Peritoneal DialysisContinuous Cycling Peritoneal Dialysis)
 IPD (Intermittent Peritoneal DialysisIntermittent Peritoneal Dialysis)
 NIPD (Nocturnal Intermittent Peritoneal DialysisNocturnal Intermittent Peritoneal Dialysis)
 TPD (Tidal Peritoneal DialysisTidal Peritoneal Dialysis)

11. Automated Peritoneal Dialysis(Automated Peritoneal Dialysis(APDAPD))
IndicationsIndications
1. Children
2. Inadequate solute or fluid removal
3. High intraperitoneal pressure Hernia
4. Polycystic disease
5. (Recurrent) dialysate leaks
6. Loss of appetite
7. Lifestyle
DisadvantagesDisadvantages
More difficult to learn Disturbed sleep
Attached to machine Sexual problems
More expensive

12. ESNT-CNE 1st
Course Cairo Sept 10-14, 2012
Optimizing PD prescription for volume control: the
importance of varying dwell time and dwell volume. M
Fischbach et al.Pediatr Nephrol 2014

13.  Easy-to-use preassembled system
◦ PD-Paed Plus is designed to perform PD manually in
premature babies, neonates and infants. It is an easy-to-use
preassembled system for in-center use.
 Flexible treatment adaptation
◦ Capacity for inflow volumes of up to 240 mL
◦ Option to connect two fluid bags at the same time

14.  Safety features give confidence
◦ An integrated ball valve in the inflow burette ensures that only
the prescribed volume is given to the patient
◦ Improved therapeutic efficiency with a low recirculation
volume of only 2 mlOur patented PIN technology reduces the
number of risk steps associated with disconnection and
reconnection
◦ DEHP-free materials ensure biocompatibility

16.  Sleep safe is a reliable and popular device to treat
children on automated PD, in general during the night
time at home. It stands out for its flexibility to tailor a
treatment according to the individual needs of the
patient:
 Adjustable flow rates for low volume treatments
 Special pediatric disposable set for low volumes
 Option to perform ‘Adapted APD (aAPD)’ to improve
patient outcome by varying dwell time, and fill volume
and glucose concentration in one treatment3

17.  Giving parents the confidence in the treatment and its
comfort
 Integrated continuous pressure monitoring helps to
prevent outflow pain
 Quiet operation
 Automatic bag connection and PIN technology reduce
contamination risk steps to one per day

19. Complications of PD therapy
infectious Non infectious
Peritonitis
Acute Chronic

20. Catheter MalfunctionCatheter Malfunction
.

21. Hyperglycaemia
Hyperlipidemia
Malnutrition
Hypokalemia
Hypermagnesaemia

22. Such variation from 2% to 80%!
Can not be for medical reasons?
PD utilization in various countries
worldwide (from USRDS data 1999(.

23. Conclusions
In conclusion, PD continues to be underutilized in many
countries, including the United States. There are many
factors that contribute to this underutilization (e.ge.g.,
modality, system, and patient-related factors).
Clin J Am Soc Nephrol 6: 447–456, 2011Clin J Am Soc Nephrol 6: 447–456, 2011

24. Damanhor
PD program inPD program in
EgyptEgypt

25. Transports
Hospitalisation
Pharmaceuticals
)e.g. EPO(
Equipment costs
)Lease, depreciation,
maintenance(
Disposables
Labor
Water Treatment
Infrastructure
Transports
Hospitalisation
Pharmaceuticals
)e.g. EPO(
Equipment costs
Disposables
Labor
Infrastructure
Hemo
PD
SchematicSchematic RRT CostRRT Cost ComparisonComparison
Available ModalitiesAvailable Modalities

27. PD in MansouraPD in Mansoura

28. PD in MansouraPD in Mansoura

29. ConclusionConclusion

30. Thank YOUThank YOU