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Peritoneal Transport Characteristics with Glucose Polymer–Based Dialysis Fluid in Children

Esther Rusthoven^*, Raymond T. Krediet, Hans L. Willems, Leo A.H. Monnens and Cornelis H. Schröder^*

*Department of Pediatric Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands; Department of Clinical Chemistry, University Medical Center St. Radboud, Nijmegen, The Netherlands; and Department of Pediatric Nephrology, University Medical Center St. Radboud, Nijmegen, The Netherlands

Correspondence to Dr. Esther Rusthoven, Department of Pediatric Nephrology, UMCU, Wilhelmina Children’s Hospital, KE 04.133.1, PO Box 85090, 3508 AB Utrecht, The Netherlands. Phone: +31-30-2504001; Fax: +31-30-2505349; E-mail: erusthovern{at}xs4all.nl

Scarce data are available on the use of glucose polymer–based dialysate in children. The effects of glucose polymer–based dialysate on peritoneal fluid kinetics and solute transport were studied in pediatric patients who were on chronic peritoneal dialysis, and a comparison was made with previously published results in adult patients. In nine children, two peritoneal equilibration tests were performed using 3.86% glucose and 7.5% icodextrin as a test solution. Dextran 70 was added as a volume marker to calculate fluid kinetics. Serum and dialysate samples were taken for determination of urea, creatinine, and sodium. After calculation of the initial transcapillary ultrafiltration (TCUF) rate, it was possible to calculate the contribution of aquaporin-mediated (AQP-mediated) water transport to ultrafiltration for icodextrin and 3.86% glucose and the part of L_pS (the product of the peritoneal surface area and the hydraulic permeability) caused by AQP. In children, the transport parameters were similar for the two solutions, except for TCUF, which was lower for icodextrin (0.9 ml/min per 1.73 m²) as compared with 3.86% glucose (4 ml/min per 1.73 m²). Transport parameters were similar in children and adults for glucose, but with icodextrin, TCUF and marker clearance were significantly lower in children. AQP-mediated water flow was 83 versus 50% with glucose (child versus adult; P < 0.01) and 18 versus 7% with icodextrin (P < 0.01). Data indicate that transport parameters in children using icodextrin are similar to glucose except for TCUF. Differences are explained by the absence of crystalloid osmosis and that TCUF was determined after a 4-h dwell. Comparison of transport parameters and peritoneal membrane characteristics between children and adults reveal that there seem to be differences in the amount and functionality of AQP. However, there are no differences in clinical efficacy of this transport pathway because the absolute flow through the AQP is identical in both groups using 3.86% glucose.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673