Peritoneal Dialysis

Abstract

Peritoneal dialysis (PD) is currently the most commonly used kidney replacement therapy (KRT) in children worldwide. In this chapter, the fundamentals of peritoneal water and solute transport are detailed, including a description of peritoneal membrane function and transport characteristics. The types of dialysis fluid and their impact on membrane preservation over time on chronic PD and the basic concepts that impact dialysis modality choice are presented. Factors influencing timing of dialysis initiation and choice of catheter and other dialysis equipment, as well as remote patient monitoring options, are reviewed. Once PD is initiated, the dose of dialysis delivered should be measured, typically by measuring urea clearance relative to solute distribution volume (Kt/V). The prescription should be tailored based on the patient’s peritoneal membrane characteristics as measured through the peritoneal equilibrium test (PET) and considering the intraperitoneal pressure. Determination of the adequacy of the dialysis procedure should also consider nutritional status, growth, and the general well-being of the patient, in addition to the correction of the metabolic derangements of chronic kidney failure. The PD procedure must be carefully monitored to avoid common and potentially lifethreatening complications. Catheter exit site infection and peritonitis are among the most important complications that require ongoing monitoring, and this chapter reviews guidelines for preventing and treating these complications. Common catheter and dialysis procedure-related complications are discussed; patient outcome on chronic PD and promising perspectives are presented.