The Choice of Dialysis Solutions in Pediatric Chronic Peritoneal Dialysis: Guidelines by An AD HOC European Committee

Abstract

Objective

To provide guidelines on choosing dialysis solutions for children on chronic peritoneal dialysis (PD).

Setting

European Paediatric Peritoneal Dialysis Working Group.

Data Source

Literature on the application of PD solutions in children (Evidence), and discussions within the group (Opinion).

Conclusions

Glucose is the standard osmotic agent for PD in children (Evidence). The lowest glucose concentration needed should be used (Opinion). Low calcium solution (1.25 mmol/L) should be applied, wherever possible, with careful monitoring of parathyroid hormone levels (Opinion). The use of amino acid-containing dialysis fluids can be considered in malnourished children, although aggressive enteral nutrition is preferred (Opinion). There is insufficient evidence documenting the efficacy of intraperitoneally administered amino acids (Evidence). When ultrafiltration and/or solute removal are insufficient, poly-glucose solutions are a welcome addition to the treatment of children on nocturnal intermittent PD (Evidence). However, in the absence of any reported long-term experience with children, their use must be closely monitored (Opinion). Bicarbonate would appear to be the preferred buffer for PD in children, but more in vivo studies are required before it replaces the present lactate-containing solutions (Evidence/Opinion).