ABC de la diálisis peritoneal en pediatría

Abstract

End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to adjust the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.