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Saudi Journal of Kidney Diseases and Transplantation
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EDITORIAL Table of Contents   
Year : 2005  |  Volume : 16  |  Issue : 1  |  Page : 1-5
Peritoneal Dialysis in Children: Consider the Membrane for Optimal Prescription


1 Pediatry 1, University Hospital, Avenue Moliere, 67098 Strasbourg Cedex, France
2 Department of Pharmacology-Physiology, EMI-U 0015, Medicine Faculty, Strasbourg, France
3 Department of Radiology, University Hospital, 67098 Strasbourg, France
4 Department of Pediatric Nephrology, Children’s Hospital, Im Neuenheimer Feld 150, 69120 Heidelberg, Germany
5 Department of Nephrology and Physiology, Goteborg University, PO Box 432, SE-40530 Goteborg, Sweden

Correspondence Address:
M Fischbach
Pediatry 1, University Hospital, Avenue Moliere, 67098 Strasbourg Cedex
France
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PMID: 18209452

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The peritoneal dialysis prescription was, for a long time, based on clinical experience and very empirical, especially for patients on continuous ambulatory peritoneal dialysis (CAPD). Better comprehension of the peritoneal membrane as a dynamic dialysis surface allows an individualized prescription, especially for children on automated peritoneal dialysis (APD). Fill volume prescription should be scaled for body surface area (mL/m˛) and not in a too low amount to avoid a hyperpermeable exchange. Fill volume enhancement should be done under clinical control and is best secured by intraperitoneal pressure measurement (IPP; cm H2O). A peak fill volume of 1400-1500 mL/m˛ could be prescribed both in terms of tolerance and of efficiency. The dwell times should be determined individually with respect to two opposite parameters namely: short dwell times which provide adequate small solute clearance and maintain ultrafiltration capacity and long dwell times which enhance phosphate clearance but can contribute to dialysate reabsorption. The new peritoneal dialysis fluids which are free of GPD's, have neutral pH and are not exclusively lactate buffered, appear as the best choice in the context of peritoneal exchange membrane recruitment and of peritoneal vascular hyperperfusion preservation.


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