Peritoneal dialysis

Can children do peritoneal dialysis?

While end stage renal disease (ESRD) can be challenging for anyone to live with, it can be particularly difficult for children, especially school-age children who are trying to fit in and make friends. Peritoneal dialysis (PD) is a home dialysis option that allows children with ESRD to dialyze at home and lead a more normal, active life while getting treatment for kidney failure.

What is peritoneal dialysis (PD)?

Peritoneal dialysis (PD) is a form of home dialysis that uses the peritoneal membrane in the abdomen to clean the patient’s blood. During a process known as an exchange, a special solution, called dialysate, is put into the peritoneal cavity through a catheter (small tube) that has been placed in the patient’s abdomen. The dialysate dwells, or stays, in the abdomen for a prescribed period of time. While it dwells, the dialysate absorbs extra fluid and wastes in the blood. When the dwell time is up, the dialysate is drained from the catheter and takes the extra fluid and wastes with it.

Two types of peritoneal dialysis (PD)

Continuous ambulatory peritoneal dialysis (CAPD)

With CAPD, the child and his or her parent or guardian manually perform the exchanges. Exchanges, which take approximately 30 minutes, are generally performed four times during the day by placing a bag of dialysate fluid on an IV pole or coat rack. Gravity then makes the filling and draining process of the exchange possible.

Automated peritoneal dialysis (APD)

Automated peritoneal dialysis (APD), commonly referred to as continuous cycling peritoneal dialysis (CCPD), requires a cycler machine to automate the filling and draining process of the exchange. Many children prefer this form of PD because it allows most of their dialysis to be performed while they sleep, freeing up the day for school and other activities.

Advantages of peritoneal dialysis (PD) for children

Pain-free

One advantage of PD for children is that their blood is cleaned inside their bodies and doesn’t require the use of needles, as is the case with hemodialysis. Many young children who are scared of needles may feel more comfortable doing PD.

Flexible treatment schedule

PD frees children from an in-center dialysis schedule and makes it possible for them to do their dialysis treatments around their own schedule instead. This allows them to be involved in more activities, go to school regularly and take part in things other children their age are doing.

No vascular access needed

Children often have small blood vessels, which makes placement of a graft or fistula for hemodialysis more difficult. Smaller-sized PD catheters work well in children, and the treatments are easily customized for kids of all sizes and ages.

Ease of travel

PD makes it easy for children and families to travel together. PD cyclers are portable, and PD supplies and dialysate can be shipped to any destination in the U.S.

Fewer dietary restrictions

Because PD is done everyday, there are fewer dietary restrictions with PD than with hemodialysis, which is performed only three times per week. This is an important benefit for children who are still growing.

Catheter placement and training for peritoneal dialysis (PD)

Before a child can begin peritoneal dialysis (PD), he or she will need to have a catheter surgically placed in his or her abdomen. A catheter is a soft, flexible tube about the length of a ruler and the width of a pencil. During surgery, one end of the catheter will be put into the child’s peritoneal cavity and the other end will come out of a tiny hole in his or her lower abdomen. Catheter placement surgery is usually done under general anesthesia, and most patients go home the day of the procedure.

When the catheter has healed and is ready to use for PD, the child and his or her parent or guardian will go through a comprehensive safety and training class at a dialysis clinic to learn to do PD. The child will take an active part in the training and will be assigned age-appropriate tasks that he or she can do during the treatment. Training will be done by a PD nurse and generally takes about two weeks. As the child gets older and learns more about PD, he or she will be able to take on more of the tasks associated with his or her treatment.

Summary

Peritoneal dialysis (PD) is an option for children with end stage renal disease (ESRD) that makes it easier for them to maintain an active lifestyle and keep up with children their age. Talk with your child’s doctor today to see if PD is the right dialysis treatment for your child.

External links

• Dealing with kidney disease in children (Part 1)
• Dealing with kidney disease in children (Part 2)