The optimal approach to peritoneal dialysis prescription in children

Objective:To describe the optimal approach to peritoneal dialysis (PD) pres cription in children. Design: Review of the available literature. Results: Unlike the situation in adults, the main method used for PD in chi ldren is automated peritoneal dialysis (APD). The prone position, while res ting, permits the dialysis prescription to use a higher fill volume (IPV), as in continuous ambulatory peritoneal dialysis (CAPD), and is also probabl y more effective than PD in an upright position. However, because APD is li mited to 10 hours, the dialytic effectiveness of nocturnal APD should avoid two potential risks: (1) use of too high an IPV per exchange, inducing lym phatic reabsorption, a factor in unsuitable water and sodium balance [Fisch bach M. Peritoneal dialysis prescription for neonates. Perit Dial Int. 1996 ; 16(Suppl):S52-4]; and (2) use of too short a dwell time per exchange, lim iting the purification of creatinine and phosphate despite an apparently ad equate urea purification (Malhotra C, Murota GH,Tzamaloukas AH. Creatinine clearance and urea clearance in PD: What to do in case of discrepancy. Peri t Dial Int. 1997; 17:532-5).