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Background <p> Automated peritoneal dialysis (APD) consists of dwells with the same dwell volume and time. New cyclers allow modification of time and volume to prescribe adapted APD (AAPD), i.e., a series of short, small dwells followed by long, large dwells. Safety, efficacy, and underlying mechanisms of AAPD in children are uncertain.</p> Methods <p>Two double mini-PET were performed in randomized sequence. The standard test consisted of two identical cycles (fill volume 1000&#xa0;ml/m<sup>2</sup>, 75&#xa0;min) and the adapted test of a short, small cycle (600&#xa0;ml/m<sup>2</sup> BSA, 30&#xa0;min) followed by a long, large cycle (1400&#xa0;ml/m<sup>2</sup>, 120&#xa0;min). Solute and water fluxes were quantified together with intraperitoneal pressure (IPP). Nine pediatric PD patients (5–21&#xa0;years) were treated per protocol.</p> Results <p>Residual dialysate volume was 422 ± 190&#xa0;ml/m<sup>2</sup> BSA. There were no differences in ultrafiltration rates, glucose uptake, and creatinine, urea, and electrolyte clearances with the adapted and standard double mini-PET, despite identical cumulative dialysate volume and time. IPP varied by 1.7 ± 3.4 (range −2 to 9) cm H<sub>2</sub>O with a drained volume of 1123 ± 386 and 1159 ± 210&#xa0;ml/m<sup>2</sup> BSA for each standard dwell. IPP decreased from 1.9 with small volume to 1.0&#xa0;cm H<sub>2</sub>O /m<sup>2</sup>/100&#xa0;ml with large volume dwells (<i>p</i> &lt; 0.001) and was above 14&#xa0;cm H<sub>2</sub>O in 21 out of 63 measurements.</p> Conclusion <p>Within the limitation of small patient numbers, this proof-of-concept study suggests similar ultrafiltration and clearance rates with a single adapted versus standard double mini-PET. High residual dialysate volumes and high IPPs highlight the challenges of AAPD prescription in children.</p> Graphical abstract <p></p>

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Randomized cross-over comparison of double mini-PET with standard versus adapted dwell volumes and dwell times in children on chronic peritoneal dialysis

  • 期刊论文

  • 发表日期：

    2025年10月16日

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  • Ariane Zaloszyc,
  • Betti Schaefer,
  • Maria Bartosova Medvid,
  • Alberto Edefonti,
  • Sara Testa,
  • Fabio Paglialonga,
  • Rukshana Shroff,
  • Armelle Doutey,
  • Johan Vande Walle,
  • Thomas Lavaux,
  • Ludovic Glady,
  • Joris Delanghe,
  • Matthijs Oyaert,
  • Laura Friebus,
  • Ivan Damgov,
  • Michel Fischbach,
  • Claus Peter Schmitt

摘要

Background

Automated peritoneal dialysis (APD) consists of dwells with the same dwell volume and time. New cyclers allow modification of time and volume to prescribe adapted APD (AAPD), i.e., a series of short, small dwells followed by long, large dwells. Safety, efficacy, and underlying mechanisms of AAPD in children are uncertain.

Methods

Two double mini-PET were performed in randomized sequence. The standard test consisted of two identical cycles (fill volume 1000 ml/m2, 75 min) and the adapted test of a short, small cycle (600 ml/m2 BSA, 30 min) followed by a long, large cycle (1400 ml/m2, 120 min). Solute and water fluxes were quantified together with intraperitoneal pressure (IPP). Nine pediatric PD patients (5–21 years) were treated per protocol.

Results

Residual dialysate volume was 422 ± 190 ml/m2 BSA. There were no differences in ultrafiltration rates, glucose uptake, and creatinine, urea, and electrolyte clearances with the adapted and standard double mini-PET, despite identical cumulative dialysate volume and time. IPP varied by 1.7 ± 3.4 (range −2 to 9) cm H2O with a drained volume of 1123 ± 386 and 1159 ± 210 ml/m2 BSA for each standard dwell. IPP decreased from 1.9 with small volume to 1.0 cm H2O /m2/100 ml with large volume dwells (p < 0.001) and was above 14 cm H2O in 21 out of 63 measurements.

Conclusion

Within the limitation of small patient numbers, this proof-of-concept study suggests similar ultrafiltration and clearance rates with a single adapted versus standard double mini-PET. High residual dialysate volumes and high IPPs highlight the challenges of AAPD prescription in children.

Graphical abstract