• End-stage renal disease.
• Acute kidney failure accompanied by 1 or more of the following:
• Oliguria or anuria.
• Uremia (azotemia accompanied by platelet dysfunction and bleeding,
change in mental status, or other uremic symptoms).
• Electrolyte or metabolic disturbance unresponsive to medical
management (eg, hyperkalemia, hyponatremia or hypernatremia, acidosis,
• Inability to provide adequate nutrition or other intravenous
therapy due to fluid restriction.
• Inborn error of metabolism: urea cycle disorders, propionic acidemia,
maple syrup urine disease (hemodialysis and CRRT more effective
and are preferred).
• Dialyzable toxin (hemodialysis and CRRT more effective and are
• Recent abdominal surgery.
• Prior extensive abdominal surgery that might have resulted in
adhesions or peritoneal scarring.
• Ventriculo-peritoneal shunt.
• Unsuitable social situation for home dialysis.
• Peritoneal dialysate solutions.
• Lactate-buffered, electrolyte-balanced dextrose solution most
• Available as 1.5%, 2.5%, and 4.25% dextrose.
• Bicarbonate-buffered solutions are available.
• Icodextrin (glucose polymer) solution available; useful for patients
with poor fluid removal.
• Solution warmer (blood transfusion warmer for continuous ambulatory
peritoneal dialysis [CAPD] or warming tray on
• Automated cycler for intermittent peritoneal dialysis (IPD) or
continuous cycling peritoneal dialysis (CCPD) or manual exchange
set for CAPD.
• Peritoneal dialysis catheter.
• Peritoneal dialysis is the preferred method of
chronic dialysis in children with end-stage renal disease.
• Children receiving peritoneal dialysis have less daytime disruption
of school and social activities.
• Because peritoneal dialysis is performed every day, a more liberal
fluid and dietary regimen is possible.
• Peritoneal dialysis might be the only option available to small
infants who cannot tolerate the large fluid shifts and large extracorporeal
circuit volume of hemodialysis, and to those patients who do not
have adequate vascular access for hemodialysis.
• However, hemodialysis might be the only option for RRT for those
children who have had extensive abdominal surgery, who have a social
situation that precludes home dialysis, or in whom peritoneal dialysis
has already failed due to repeated bouts of peritonitis or other
• Hemodialysis and CRRT remain the treatments of choice for inborn
errors of metabolism and toxic ingestions because peritoneal dialysis
does not provide efficient and rapid clearance of metabolites and
• Renal replacement therapy (RRT) refers
to any procedure whereby solute or water, or both, are removed from
the body, generally during acute or chronic kidney insufficiency.
• RRT can be divided into intermittent or continuous ...
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