- Dialysate solutions
Dialysate solutions for PD have physiologic concentrations of electrolytes
such as sodium, chloride, magnesium and calcium. Hypertonic dextrose
(2.5%) have been traditionally used in the dialysate solutions as an
osmotic agent but was associated with peritoneal neoangiogenesis and
fibrosis due to nonenzymatic glycosilation of proteins.[19] Recently,
hypertonic glucose has been replaced by glucose polymers such as
icodextrin which provide a more stable osmotic pressure and avoid the
mentioned side effects.
The preferred buffer for PD is lactate. Bicarbonate and acetate are rarely
used as they commonly produce calcium precipitation and changes in the
structure of the peritoneum, respectively.
Protein losses during PD lead to common malnutrition and
hypoalbuminemia. The addition of amino acids to the dialysate solution,
proved to be beneficial to improve the nutritional status of the
malnourished child on PD. [50] Furthermore, amino acids can be used as
an alternative osmotic agent with comparable results.[49]
- Dialysis is usually started 2 weeks after catheter placement to allow for
adequate healing, incorporation of the cuffs and avoid leaks. For children
with no other access, low volume dialysis in the supine position may be
started in the first 24 hours without a significant risk of leak or subsequent
infection and survival of the catheter.[43]
- Exchange volume
The exchange or “fill” volume is approximately 600 - 800 mL/m2 in children
<2
years and 100-1200 mL/m2 in children >2 years old.
