The choice of dialysis fluids in children with stage 5 chronic kidney disease

Abstract

Peritoneal dialysis is the most frequent form of dialysis delivered to children with end stage renal disease. Traditional dialysis fluids exert a toxic effect on the peritoneum due to their acidity, high glucose and lactate concentrations and an elevated level of glucose degradation products (GDP). The newer dialysis fluids are more biocompatible. Preservation of the peritoneal membrane dialysis and ultrafiltration function is of utmost importance in children due to their increasing life expectancy which is dependent on continuing renal replacement therapies. The European Paediatric Dialysis Working Group (EPDWG) recommends the use of biocompatible dialysis fluids in children with the lowest possible glucose concentration and lowest GDP content, neutral pH and bicarbonate buffer. Double or triple compartment bags are the standard for children. Icodextrin and aminoacid solutions are a helpful alternative to glucose as an osmotic agent. With an individualized prescription and new dialysis fluids children can be provided with peritoneal dialysis that is as effective but also safer than that delivered with traditional fluids.