PERITONEAL EQUILIBRATION TEST CURVES AND ADEQUACY OF DIALYSIS IN CHILDREN ON AUTOMATED PERITONEAL-DIALYSIS

Peritoneal equilibration tests (PETs) and adequacy studies have been performed to guide dialysis prescriptions in adult continuous ambulatory peritoneal dialysis patients, although few studies have been reported in pediatric patients an nightly cycling peritoneal dialysis. We performed 49 PETs in 28 children on automated peritoneal dialysis (mean age, 8.9 years; age range, 0.2 to 19.8 years; mean time on dialysis, 14.1 months) using Dianeal 2.5% dialysate (Baxter Healthcare Corp, McGaw Park, IL) inflow volumes of 1,200 mL/m(2) (approximately 40 mL/ kg), and standard technique. Mean 4-hour dialysate/plasma creatinine was 0.73 +/- 0.12 (range, 0.45 to 1.03). Mean 4-hour dialysate glucose/initial dialysate glucose was 0.28 +/- 0.10 (range, 0.06 to 0.50). Eighty percent of these PETs fell into the high average/high solute transport categories proposed by Twardowski, based on adult PETs. Twenty-four-hour dialysate collections were analyzed in 28 patients for protein loss and glucose absorption, as well as for calculation of weekly Kt/V. Mean weekly Kt/V was 1.94 +/- 0.94 (range, 0.63 to 5.10). Mean dialytic creatinine clearance calculated from the 4-hour dwell was 5.6 +/- 1.0 mL/min/1.73 m(2) (56 L/wk/1.73 m(2)). Mean daily protein loss was 0.20 +/- 0.13 g/kg/d (range, 0.2 to 9.1 g/d) and glucose absorption was 3.49 +/- 2.24 g/kg/d (range, 17 to 198 g/d). Our results show higher solute diffusion rates in children compared with the published adult PET results (P = 0.0013 and P < 0.0001 for 4-hour creatinine and glucose results, respectively), with trends toward more rapid solute transport in younger compared with older children. Peritoneal equilibration test curves should therefore be standardized for the various pediatric age groups. Kt/V and creatinine clearance determinations must be further studied to be useful in prescribing pediatric continuous cycling peritoneal dialysis and nightly intermittent peritoneal dialysis regimens. As protein losses and glucose absorption can vary considerably between patients, both should be quantified to prescribe optimal nutritional intake for individual children on continuous cycling peritoneal dialysis. (C) 1994 by the National Kidney Foundation, Inc.