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M. Fischbach*, C. Dheu*, A.C. Michallat*, B. Escande**,
V. Laugel*, M. Barthelmebs**, G. Zoellner***, F.
Schaefer****, C.P. Schmitt****, B. Haraldsson *****, J.
J. Helwig**
*Pediatry 1, University Hospital, Avenue Moliere, 67098
Strasbourg Cedex, France,
**Department of Pharmacology-Physiology, EMI-U 0015,
Medicine Faculty, Strasbourg, France, *** Department of
Radiology, University Hospital, 67098 Strasbourg,
France,
**** Department of Pediatric Nephrology, Children’s
Hospital, Im Neuenheimer Feld 150, 69120 Heidelberg,
Germany, *****Department of Nephrology and Physiology,
Goteborg University, PO Box 432, SE-40530 Goteborg,
Sweden
ABSTRACT. 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/m²)
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/m² 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.
Key Words: Peritoneal dialysis, Children, Fill
volume, Dwell time, Peritoneal membrane
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