The document outlines the principles and processes of peritoneal dialysis (PD) in children, including various modalities, indications, contraindications, and assessment of adequacy. It emphasizes the importance of patient-specific adjustments to PD prescriptions and highlights potential complications. Nutrition considerations and the role of residual renal function in therapy are also discussed.

1. Peritoneal Dialysis in Children
Hooman N
Professor
IUMS
2016

2. Modalities of renal replacement therapy
Interchangeable, depends on residual renal function

3. Peritoneal dialysis - outline
• Principles of PD
• PD solutions / PD catheter
• Indication / contraindication of PD
• PD schemes : CAPD, CCPD
• Assessement of PD adequacy/ Peritoneal
function/ultrafiltration
• Complications- Infectious/Non-infectious
• Perspectives – new dialysis solutions

4. Hooman N,et al. - Arch Iranian Med 2009;12 (1): 24 -8
The Etiology of end stage renal disease in
patients on CAPD (1993-2006)
Hereditary/metabolic 37(31%)
CAKUT 39(32.5%)
Cystic renal disease 20(17%)
Primary glomerulopathy 10(8%)
Unknown 14(12%)
Total 120(100%)

5. Principles of peritoneal dialysis

6. Scheme of peritoneal solute transport by diffusion
through the pores of capillary wall

7. Ramesh Khanna & Karl D. Nolph
Model of transport - 3 sorts of poresModel of transport - 3 sorts of pores

8. Peritoneal Dialysis FluidPeritoneal Dialysis Fluid

9. 1.5 %
Solution
2.5 %
Solution
4.25 %
Solution
Osmotic Pressure of Dextrose
Solution

10. PD Catheters

11. Initiation of PD
• Start  one – two wks after Cath. insertion
• Fill volume
– 10ml/kg/dose increase within one week to
– 1100ml/m2 children above one year
– 600-800 ml/m2 children below one year
• Dwell Time  According PET
– Low transporter
– High transporter
– High average/ low average

12. • Dwell Time  According PET
– Low transporter
– High transporter
– High average/ low average
• IPP
– Children below 2 yrs 8-10 cm H2O ( 800 ml/m2)
– Above 2 yrs 13-14cmH2O (1400ml/m2)

13. Contraindications to CPD
● Omphalocele
● Gastroschisis
● Bladder exstrophy
● Diaphragmatic hernia
● Obliterated peritoneal cavity and peritoneal
membrane failure

14. Relative contraindications to CPD include:
● Impending abdominal surgery.
● Impending (<3 months) living-donor kidney
transplantation
● Lack of an appropriate caregiver for home therapy.
● Patient/caregiver choice for hemodialysis, which is
available and medically suitable

15. Choice of Modality
• Continuous ambulatory peritoneal
dialysi(CAPD)
• Automated peritoneal dialysis (APD)
– NIPD
– CCPD
– TPD

16. Peritoneal Membrane Function
• Ultrafiltration ( UF)
• Clearance ( KT/V)
• PET
– D/Pcr
– D/D0 Glucose
Dialysis Mode
Dwell time
PD solution
Fill volume/ Number of exchange
Dialysis Mode
Dwell time
PD solution
Fill volume/ Number of exchange

17. Complications
• Infectious
– Peritonitis
• Bacterial
• Fungal
• Culture negative
• Eosinophilic
– Exit site
– Tunnel

18. • Mechanical
• Technical
– Ultrafiltration failure
– Catheter –related
• Encapsulated Peritoneal Sclerosis

19. Nutrition
• Energy = (0.45wt)49 (ideal weight/age/HT)
– CHO 45-65%
– Fat 30-40%
– Protein 5-20%
• Protein = DRI+ 0.15-0.3 g/kg/d
– DRI: 1.5 0.85
• Na
• polyuric 4-7mmol/kg/d
• Hypertensive 1-2 mmol/kg/d
• K
– 1-3 mmol/kg/d

20. Take Home Message
• RRT interchangeable during whole life
• Preserve Peritoneum
• Preserve RRF
• Individually adjust PD prescription
• Check peritoneum function accordingly
• Consider nutrition