THE USE OF THE PD ADEQUEST MATHEMATICAL-MODEL IN PEDIATRIC-PATIENTS ON CHRONIC PERITONEAL-DIALYSIS

Objective: To test the accuracy of the PD ADEQUEST kinetic model in ca lculating peritoneal transport parameters and to quantify the differen ces between the results of software simulations and direct measurement s in order to assess the reliability of this tool in chronic peritonea l dialysis (PD) pediatric patients. Patients:Twenty-nine patients (mea n age: 10 +/- 4 years; range: 4 - 17), 5 on continuous ambulatory PD, 4 on continuous cycling PD, 19 on nocturnal intermittent PD and 1 in n octurnal tidal PD, all free from peritonitis in the previous 2 months. Fourteen patients were anuric and 15 had a mean glomerular filtration rate of 1.79 +/- 1.23 mL/min, range 0.25 - 4.32. Methods: In all pati ents, 24-hour dialysate and urine collections associated to standard p eritoneal equilibration test (PET) were performed using their usual di alytic regimen and fill volume (1023 +/- 159 mL/m(2) BSA, range 614 - 1361). PD ADEQUEST kinetic parameters were compared with pediatric and adult data from literature. The measured weekly normalized total crea tinine clearance (CRCL), weekly total Kt/V, and daily net ultrafiltrat ion (UF) were compared with corresponding mathematically modeled value s. Results: Kinetic parameters calculated by the PD ADEQUEST program w ere comparable to adult and pediatric values from previous studies aft er normalization for BSA. Measured and modeled CRCL and Kt/V showed a good agreement [concordance correlation (rc) 0.937 and 0.763, respecti vely] with limited median percentage absolute errors (11.6% and 10.2%, respectively). Ultrafiltration showed less favorable results (rc = 0. 600 and median percentage absolute error 45%) probably owing to the wi de variability of this parameter. When the analysis was restricted to the peritoneal component, the re coefficients results were 0.745 for C RCL and 0.512 for Kt/V (median absolute error: 11.6% and 15.2%, respec tively). Conclusions:The overall findings of our study show that the P D ADEQUEST kinetic model can be used in pediatric patients for the cal culation of kinetic indexes and for