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Peritoneal dialysis in children with end-stage renal disease

Nature Reviews Nephrology volume 7, pages 659–668 (2011)Cite this article

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Abstract

Peritoneal dialysis is the preferred chronic dialysis modality for most children owing to its almost universal applicability and superior compatibility with lifestyle over other modalities. Although technological advances and increasing clinical experience have impacted favorably on patient and technique survival, clinical research in pediatric peritoneal dialysis has been hampered by the low incidence of end-stage renal disease (ESRD) in the pediatric population. To overcome this limitation, several international registries have emerged in the past few years to complement other long-standing registries, which together have provided useful information regarding technique-specific complications and comorbidities associated with ESRD in children undergoing chronic peritoneal dialysis. In this Review, we summarize the most relevant findings from these studies, highlighting the substantial variation in patient conditions, peritoneal dialysis practices and management of comorbidities encountered in different parts of the world.

Key Points

  • Infection, ultrafiltration failure and adhesions are the most common causes of technique failure in children receiving peritoneal dialysis

  • Marked regional variation exists regarding the spectrum and antibiotic susceptibility patterns of bacteria causing peritonitis associated with peritoneal dialysis in children

  • The prevalence of hyperphosphatemia, severe hyperparathyroidism and bone disease in children on peritoneal dialysis shows marked global variation, being highest in the Americas and lowest in Asia and Europe

  • Early enteral feeding improves weight gain and can cause obesity in infants on peritoneal dialysis, but its efficacy in preventing growth failure is limited

  • Arterial hypertension is present in two-thirds of children undergoing chronic peritoneal dialysis and uncontrolled hypertension in one-third of these children

  • Left ventricular hypertrophy is present in 50% of children undergoing chronic peritoneal dialysis; fluid overload, hypertension and hyperparathyroidism are the most important risk factors for left ventricular hypertrophy

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Figure 1: Distribution of peritonitis culture results according to geographical regions.
Figure 2: Variation in the control of iPTH levels by country.
Figure 3: Percentage of patients with alterations of bone and mineral metabolism stratified by time-averaged mean PTH levels.
Figure 4: Time-averaged mean plasma iPTH concentrations and change in standardized height.
Figure 5: LVMI in 507 children receiving chronic peritoneal dialysis followed in the International Pediatric Peritoneal Dialysis Network Registry.

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Authors and Affiliations

  1. Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany

    Franz Schaefer

  2. Section of Pediatric Nephrology, Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, 64108, MO, USA

    Bradley A. Warady

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F. Schaefer and B. A. Warady contributed equally to discussion of content for the article, researching data to include in the manuscript and reviewing and editing of the manuscript before submission.

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Correspondence to Franz Schaefer.

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Competing interests

F. Schaefer has received a grant/research support from Fresenius Medical Care. B. A. Warady has received a grant/research support from Baxter Healthcare.

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Schaefer, F., Warady, B. Peritoneal dialysis in children with end-stage renal disease. Nat Rev Nephrol 7, 659–668 (2011). https://doi.org/10.1038/nrneph.2011.135

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