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Pediatric Peritoneal Dialysis: An Overview
1. Pediatric Peritoneal Dialysis
Dr. Osama El-ShahatDr. Osama El-Shahat
Consultant Nephrologist
Head of Nephrology Department
New Mansoura General Hospital (international)
ISN Educational Ambassador
2. 11stst
steps towards peritonealsteps towards peritoneal
dialysis.dialysis.
Ancient Egypt were probably the first people to get a look at the peritoneum
The word preitoneum refers to the Greek word “peritononionperitononion” and means to stretch.
3. PD … the modality first used for thePD … the modality first used for the
treatment of KItreatment of KI
4. Managing New Patient with ESRD
“Complementary Not Competitive” Coles 1998
“The right modality at the right time. PeterBlake, MD, John Burkart,
Early referral of patient
With CKD to renal center
Pre-emptive
Transplantation
PD as first option if medically suitable
Allowing for patient chioce
Patient education
program
HD Transplant
PDPD
5. Why to start with PD?
Preservation of RRF
Higher Hb concentration
Less risk of acquiring blood borne infections e.g. HCV
Better quality of life
Travel , employment
It allows expansion with limited resources
Lower staff / patient ratio
saves vascular access
preferred for children (APD)
6. Peritoneal dialysis (PD) is in general the preferred treatment
modality for pediatric patients to bridge the time until
transplantation.
It is easier to perform, less invasive than extracorporeal
treatments and does not require anticoagulation. However,
what counts most for the child and the family is that PD can
be carried out at home.
PD is more compatible with a “normal” lifestyle and allows a
better psychosocial integration of the little patient.
7. Patient selection
PositivePositive NegativeNegative
Selecting RRT modalities is influenced by a number of
considerations such as
Patient Preference .
Availability And Convenience.
Underlying Medical Problems and Comorbid Conditions.
Socioeconomic and Dialysis Center Factors.
The Patient's Home Situation
Medical staff Training.
11. Automated Peritoneal Dialysis(Automated Peritoneal Dialysis(APDAPD))
IndicationsIndications
1. Children
2. Inadequate solute or fluid removal
3. High intraperitoneal pressure Hernia
4. Polycystic disease
5. (Recurrent) dialysate leaks
6. Loss of appetite
7. Lifestyle
DisadvantagesDisadvantages
More difficult to learn Disturbed sleep
Attached to machine Sexual problems
More expensive
12. ESNT-CNE 1st
Course Cairo Sept 10-14, 2012
Optimizing PD prescription for volume control: the
importance of varying dwell time and dwell volume. M
Fischbach et al.Pediatr Nephrol 2014
13. Easy-to-use preassembled system
◦ PD-Paed Plus is designed to perform PD manually in
premature babies, neonates and infants. It is an easy-to-use
preassembled system for in-center use.
Flexible treatment adaptation
◦ Capacity for inflow volumes of up to 240 mL
◦ Option to connect two fluid bags at the same time
14. Safety features give confidence
◦ An integrated ball valve in the inflow burette ensures that only
the prescribed volume is given to the patient
◦ Improved therapeutic efficiency with a low recirculation
volume of only 2 mlOur patented PIN technology reduces the
number of risk steps associated with disconnection and
reconnection
◦ DEHP-free materials ensure biocompatibility
15.
16. Sleep safe is a reliable and popular device to treat
children on automated PD, in general during the night
time at home. It stands out for its flexibility to tailor a
treatment according to the individual needs of the
patient:
Adjustable flow rates for low volume treatments
Special pediatric disposable set for low volumes
Option to perform ‘Adapted APD (aAPD)’ to improve
patient outcome by varying dwell time, and fill volume
and glucose concentration in one treatment3
17. Giving parents the confidence in the treatment and its
comfort
Integrated continuous pressure monitoring helps to
prevent outflow pain
Quiet operation
Automatic bag connection and PIN technology reduce
contamination risk steps to one per day
18.
19. Complications of PD therapy
infectious Non infectious
Peritonitis
Acute Chronic
22. Such variation from 2% to 80%!
Can not be for medical reasons?
PD utilization in various countries
worldwide (from USRDS data 1999(.
23. Conclusions
In conclusion, PD continues to be underutilized in many
countries, including the United States. There are many
factors that contribute to this underutilization (e.ge.g.,
modality, system, and patient-related factors).
Clin J Am Soc Nephrol 6: 447–456, 2011Clin J Am Soc Nephrol 6: 447–456, 2011