Nephrol Dial Transplant (2002) 17: 380–385
Special Feature
Guidelines by an ad hoc European committee on adequacy
of the paediatric peritoneal dialysis prescription
Michel Fischbach1, Constantinos J. Stefanidis2 and Alan R. Watson3 for the European Paediatric
Peritoneal Dialysis Working Groupy
1
Centre Hospitalier Regional et Universitaire, Hopital de Hautepierre, Strasbourg, France, 2A&K Kyriakou Children’s
Hospital, Athens, Greece and 3Children and Young People’s Kidney Unit, Nottingham City Hospital, Nottingham, UK
Keywords: adequacy; dialysis prescription; paediatric;
peritoneal dialysis
Introduction
Continuous ambulatory peritoneal dialysis (CAPD)
has been used in children since 1978 and was rapidly
adopted as a home dialysis method. In more recent
years, the availability of reliable and portable machines
has increased the usage of automated peritoneal
dialysis (APD), which now exceeds the use of CAPD
in most western countries w1x.
The prescription of APD is based on an assessment of
the needs of the patient with monitoring of bio-
chemistry at regular intervals. The age of the child,
the residual renal function, the nutritional intake, the
acceptability of the regime to the child and family
are all part of the assessment. Historically, children
were prescribed CAPD on an initial regime of four bag
changes a day with fill volumes of 30–50 mlukg body
weight per bag.
Dialysis adequacy is a concept introduced in the
late 1980s, first in haemodialysis and subsequently in
peritoneal dialysis (PD), linking outcomes to adequacy
targets. Satisfactory or good dialysis could be viewed
as the dose of dialysis below which a significant
increase in morbidity and mortality would occur. It
should not be confused with optimal dialysis, which
Correspondence and offprint requests to: Dr Alan R. Watson,
Children and Young People’s Kidney Unit, Nottingham City
Hospital, Hucknall Road, Nottingham NG5 1PB, UK. Email:
watpaed@aol.com
y particularly in infants and small children has been
C. Schroder, Wilhelmina Kinderziekenhuis, Utrecht, The
Netherlands; A. Zurowska, Medical University of Gdansk,
Gdansk, Poland; V. Strazdins, University Hospital, Riga, Latvia;
K. Ronnholm, University of Helsinki, Helsinki, Finland; E. Simkova,
University Hospital Motol, Prague, Czech Republic; A Edefonti,
Clinica Pediatrica C&D de Marchi, University of Milan, Italy.
# 2002 European Renal Association–European Dialysis and Transplant Association
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is the dose of blood purification beyond which no
further improvement in the patient’s clinical well-being
can be achieved.
Adequacy targets have been defined in adults because
patient mortality and morbidity is much easier to
define w2x. There are much smaller numbers of pae-
diatric patients with varying body size and physical
status who often spend shorter periods of time on
dialysis before the favoured treatment of transplanta-
tion. There are few data to correlate the clinical
outcomes with delivered dialysis dose in children w3,4x.
The European Paediatric Peritoneal Working Group
was established in 1999 by paediatric nephrologists
with a major interest in PD. The group has already
published guidelines on commencing elective chronic
PD w5x. These guidelines were initiated and discussed
at meetings of the group and developed by e-mail
discussion to develop a consensus of opinion based
upon cumulative clinical experience and reported
studies. This paper will discuss factors influencing the
dialysis prescription and how such a prescription can
be modified for different clinical circumstances.
Peritoneal membrane characteristics
Area and fill volume
The efficiency of PD is to a large part dependent on the
transference properties of the peritoneal membrane.
The area of the peritoneal membrane is 2-fold larger
in infants than in adults at 533 vs 284 cm2ukg body
weight, respectively, although the surface area is age
independent if expressed per m2 body surface area w6x.
Therefore, scaling of the dialysate fill volume by BSA,
proposed w7–10x to avoid the false perception of
peritoneal hyperpermeability (as defined in a periton-
eal equilibration test (PET)) w9–11x in children com-
pared with adults when prescribing fill volume scaled
simply to weight.
Paediatric peritoneal dialysis prescription
Vascular pore surface area
The effective peritoneal membrane area available for
dialytic exchange can be determined using the three-
pore model w12x. This calculated area is the vascular
surface area involved for the exchanges, thus called
effective area.
. Age independency for children vs adult patients
if fill volume scaled for BSA (m2) w12–14x.
. Fill volume and patient posture are factors of
vascular pore area recruitment w14x: a fill volume
of 1400 mlum2 with the patient in the supine posi-
tion, appears optimal both in terms of efficiency, (i.e.
mass transfer coefficient) and in terms of tolerance,
(i.e. peritoneal pressure) w9,15,16x. This optimal
fill volume should only be considered as a maximal
target and not a requirement to achieve adequacy
of dialysis.
Fill volume
Low peritoneal fill volume: a risk factor?
A low fill volume is correlated to a hyperpermeable
state as defined in a PET w7,9,10x. A hyperpermeable
state is a risk factor for ultrafiltration failure w10,17x
and increased mortality and morbidity in adults w17x.
In children a hyperpermeable state has been linked to
impaired statural growth rate despite an enhanced
acquisition of body weight w18x. In this study the mean
fill volume prescribed for the APD patients (58%)
was 824"125 mlum2 BSA and for the CAPD patients
(42%) 1019"174 mlum2. This is in fact a low-range
fill volume prescription for the APD patients with
potential impact on peritoneal permeability w7,9,10x.
Nevertheless, in this study w18x the adequacy para-
meters referring to the guidelines were in a normal high
range for KtuV urea, i.e. 2.42 per week, contrasting
with a normal low range for creatinine clearance,
i.e. 55 lu1.73 m2 BSA per week. Such discrepancy w18x
between urea and creatinine parameters of adequacy is
often described in case of a hyperpermeable peritoneal
state even in adults w19x. Therefore, we speculated that
prescribing a low fill volume w18x should be considered
as a potential risk factor able to induce a hyper-
permeable peritoneal state with potential impact on
growth w18x. This speculation should be validated by
studies.
High peritoneal fill volume: a risk factor?
An excessive fill volume may contribute to patient
morbidity by causing the following complications:
pain, dyspnoea, hydrothorax, hernia formation w20x,
gastro-oesophageal reflux with anorexia, loss of ultra-
filtration by enhanced lymphatic drainage w21x. Such
morbidity could result in patient non-compliance.
Increasing the fill volume over a so-called peak
volume w22,23x will not improve dialysis efficiency,
but may even reduce it w22x.
381
Optimal peritoneal fill volume
The historical prescription of 30–50 mlukg body weight
should be replaced by a fill volume scaled for BSA,
taking into account the age of the patient, the modality
of PD used, i.e. CAPD or APD and the time already
spent on PD, which leads to greater patient toler-
ability. In practice the fill volume is lower in infants
compared with children, is lower per day, i.e. CAPD,
compared with night, i.e. APD. A fill volume of over
1400 mlum2 BSA may increase morbidity without
demonstrable gain and a too low fill volume could be
a risk of hyperpermeability w23x.
The fill volume should, therefore, be adapted
individually under clinical control, (i.e. i.p. pressure
measurements) w15,16x and biological adequacy para-
meters, (i.e. urea and creatinine levels at follow up
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clinic visits).
Peritoneal permeability
A standardized PET is now used to categorize the
solute transport capacity of an individual patient w4,7x.
The determination of a patient’s transporter state is
of immediate clinical use in choosing the most appro-
priate PD modality and guiding the prescription in
the individual patient. It is important to note that the
reproducibility of PET tests depends upon standardized
test conditions. It is also important to consider the
new concept of functional vs organic hyperpermeable
peritoneal state w23,24x:
. organic hyperpermeability: effective vascular pore
area increment, i.e. neoangiogenesis, high pore
density;
. functional hyperpermeability: as seen in case of low
fill volume prescription w9,10,15x. This condition is
presumably related to the ratio between a normal
vascular pore surface area, i.e. normal pore density,
and a low amount of fill volume w14x.
How to perform a PET z
The results of a PET are in part dependent from the
fill volume used w4,7,10,15x. Therefore, standardized
test conditions are of importance. In Europe w4x, a
fill volume of 1000 mlum2 BSA and in USA w7x a fill
volume of 1100 mlum2 BSA were used to develop
‘normal’ charts. This standardized fill volume permits
definition of the initial peritoneal permeability and
monitoring of changes with time. The dextrose con-
centration used for standard curves determinations
was 2.5% glucose dialysate. The use of 3.86u4.25%
glucose solution should be prefered to improve the
accuracy of ultrafiltration assessment and analyse the
sieving of sodium w25–30x.
z
Supporting material is available to subscribers with the on-line
version of the journal at the journal website.
382
The PET should be performed at least after a delay of
1 month from the surgical catheter implantation or
from a peritonitis episode. The frequency of PET
testing has not been determined but may be as often as
two to four times per year. A more complete, but also
more complicated test could allow w13,14x an effective
peritoneal membrane area to be determined.
It is of importance to note first that this standardized
fill volume could be different from the prescribed
fill volume. Secondly, that the PET is conducted in a
patient in a supine position. Therefore, the use of
a ‘standardized’ PET for PD prescription assistance
remains a matter of debate.
Some teams w9,31,32x use the APEX time ultrafiltra-
tion time and the purification phosphate time, both
obtained from a PET as a help for PD prescription.
Urea and creatinine adequacy parameters
The recommendations for adult patients w2x are given
in Table 1. In children, a KtuVurea over 2 has to
be achieved, but this may be difficult in those who are
anephric or with minimal residual function unless
additional dialysis is employed w26x. There are no data
evaluating the reality or not of the risks related to an
‘over dialysis’. As urea purification capacity, KtuV is
expressed per litre body water, i.e. correlated to body
weight and on the contrary creatinine clearance is
expressed per BSA, an age influence on these two
adequacy parameters is presumed. Thus, in small
children and in infants KtuVurea is likely to be in a
higher range than creatinine clearance for a given
prescription compared to older children, because of
the age impact on scaling for body weight or body
surface area. This discrepancy between urea and
creatinine adequacy parameters in small children and
in infants might be explained by the result of the
higher ratio of BSAuweight in this age group. In
addition there are no data of optimal adequacy
parameters in this age group. Therefore, the adult
dose recommendations for PD adequacy might not
be relevant for these patients.
Table 1. The adult dose recommendations (DOQI guidelines;
1997 from ref. w2x) for peritoneal dialysis adequacy
CAPD CCPD NIPD
Weekly Ktuurea (whole body 2.0 2.1 2.2
urea clearance)
Weekly CrCl (lu1.73 m2uweek) 60 63 66
(creatinine clearance)
CAPD, continuous ambulatory peritoneal dialysis; CCPD, continu-
ous peritoneal dialysis cyclic; NIPD, Nocturnal intermittent
peritoneal dialysis. Note that 1 mlu1.73 m2umin of CrCl is equal
to 10 lu1.73 m2uweek; 0.1 KtuV urea per week appears equal to
3 lu1.73 m2uweek CrCl.
M. Fischbach et al.
Discrepancy between urea and creatinine
adequacy parameters
Although urea clearance appears to be mostly related
to the total dialysate volume and, therefore, directly
influenced by the fill volume per cycle and the number
of cycles, the evidence is that phosphate and other
solutes like creatinine are predominantly affected by
the duration of the dwell time w22,34–36x. In fact a
discrepancy between urea and creatinine parameters
of PD adequacy w36x is often noted in APD patients
w19,34–36x when one is using a high amount of total
dialysate volume despite reduced dwell times. The
same discrepancy between urea and creatinine puri-
fication parameters is also noted when there is a
hyperpermeable peritoneal state w17,18x or when one
is using a high amount of total dialysate volume
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despite reduced dwell times w36–38x. Children with a
significant amount of residual renal function tend to
have a high ratio of total creatinine clearance over
KtuV, where as anuric patients have a lower ratio w37x.
Practical guidelines for prescription
CAPD prescription
CAPD is a simple method to use and is usually
effective in patients with residual renal function. The
existence of a large abdominal volume during daytime
activities is often a source of discomfort for patients
and there may be body image issues in older children.
Prolonged peritoneal contact induces a degree of con-
tinuous hyperglycaemia with repercussions for the
appetite and metabolism, particularly lipids.
Initial prescription
. Number of exchanges per day: four, sometimes three
or five, according to the age and residual renal
function.
. Fill volume per exchange: 600–800 mlum2uday, 800 –
1000 mlum2 overnight according to age and toler-
ance.
. Dialysis solutions:
glucose solution with lowest concentration (1.36%)
wherever possible;
if additional ultrafiltration is necessary then hyper-
tonic glucose dialysis should be added for the
longest dwell time, i.e. overnight. Increasing the
need for ultrafiltration will require hypertonic
solutions during the day.
. Disconnectable system with double bag type Y set
preferred.
Adapted prescription
. Number of exchanges can be increased to five per
day but this has limited acceptability due to the
chronic work demands placed upon the familiy and
difficulties arranging exchanges at school.
Paediatric peritoneal dialysis prescription
. Fill volume per exchange increase:
this can be done by gradual increase and
assessing clinical response or by i.p. pressure
measurement w15x;
1000–1200 mlum2 for the day exchanges, sometimes
1400 mlum2 for the night exchange w22x.
. Dialysis solutions: if there is inadequate filtration
overnight due to high glucose reabsorption, then
icodextrine dialysis solutions could be considered.
However, there is limited experience of the long-term
use in children w39x.
. Nutritional requirements of children are best met by
oral supplements or gastrostomyunasogastric feeding
w40x. Amino acid dialysis solutions have a place in
certain situations w41x.
. Solutions containing lower amounts of calcium
may be required when hypercalcaemia is noted,
especially with the use of calcium carbonate
phosphate binders.
. Sodium supplements (orally given) are most often
needed in young infants. This may be due to loss
of sodium in the residual urine volume in children
with uropathies anduor the ultrafiltrate sodium
content.
Notes
Individual prescription for each patient on CAPD is
recommended in terms of tolerance and effective-
ness; this individual prescription has to be adapted to
the changes of the patient’s condition especially the
progressive reduction of the residual renal function
with time. There may be difficulties achieving the dry
weight related to inadequate ultrafiltration, which are
likely to be secondary to a hyperpermeable peritoneal
membrane state. Shorter dwell times can be tried, but
it is difficult to increase the number of exchanges
because of the burden upon the families. In these cases
APD modalities should be considered.
APD prescription
This is the main PD modality used in children
principally because of freedom for school and social
activities during the day. It can be adapted quickly to
their needs with short durations of dwell times, dif-
ferent types of modalities such as continuous cycling
peritoneal dialysis (CCPD), nocturnal intermittent
peritoneal dialysis (NIPD), continuous optimal peri-
toneal dialysis (COPD) and tidal peritoneal dialysis
(TPD).
The use of APD enables the dialysis prescription to be
tailored more closely to the individual patient,
especially those with peritoneal hyperpermeability.
Technical advances of cyclers, e.g. reduction in their
size, have made the APD treatment even more
attractive. The use of computerized cards in cyclers
enables accurate measurement of the delivered dialysis
dose and assessment of patient compliance.
383
Initial prescription
. NIPD if significant residual urine volume, or CCPD
with initially half volume daytime dwell if little or no
residual function.
. Number of sessions per week: it should be
performed daily, but in those with urine output an
occasional night off for social reasons should
be considered.
. Duration of a session: 9–12 h.
. Fill volume: 800–1000 mlum2 according to age and
tolerance.
. Number of exchanges per session: 5–10. In young
infants it often needs 10 exchanges.
. Dialysis solutions: 1.36% glucose and higher hyper-
tonic glucose solutions depending upon the ultra-
filtration requirements. Usually 2.25% or greater
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dialysis solution is limited to one-third of the total
amount of dialysate used for the session in order
to limit the negative impact of glucose on the
peritoneal membrane.
Adapted prescription
. If an increased dialysis dose is required, the NIPD
modality should be optimized. First, increase the
total amount of fill volume per session to at least
8 lum2 BSA w42x. Increasing the fill volume in steps
could help to reach the maximal fill volume of
1400 mlum2, but in current practice this theoretically
optimal fill volume is rarely achieved in terms of
tolerance. Secondly, increase the duration of over-
night cycles as near as possible to 12 h, but note has to
be taken of the patient’s social and school life.
. If NIPD not fully effective, CCPD should be
considered. The choice of the dialysis solution
during the long daytime dwell exchange should be
influenced by the final goal. Icodextrin solution w39x
is able to limit dialysate reabsorption over day
and, therefore, increase dialysis efficiency. In case of
dialysate reabsorption, the dialysate solution could
be isotonic solution if only hydration is required
or amino acid solution if nutrition assistance is
wished. In case of no reabsorption over the day
1.36% dextrose could be used. In case of need for
ultafiltration higher hypertonic glucose solution
could be used.
. In a third step, the other APD modalities should
be considered. COPD with a dialysis exchange at
mid-day or one or two exchanges after school time
before the overnight cycler session. Usually these
day exchanges could be performed using the cycler
in a disconnectable manner. It may also be con-
venient for some patients who want to do an
exchange after school to delay connecting to the
cycler because of evening activities.
. Tidal dialysis used for NIPD or CCPD is recom-
mended in case of pain during the drainage phase or
is also suitable for patients with hyper- anduor
normoperitoneal permeability requiring maximum
purification limited to the overnight session w9x.
384
Conclusions
In recent years the dialysis prescription has become
more individually adapted to each patient. The
availability of new dialysis solutions and the increased
utilization of automated PD dialysis have allowed
us to tailor proposed dialysis dose to the patient’s
nutritional requirements and residual renal function.
Acknowledgement. We thank Baxter Healthcare Ltd for an
educational grant towards meetings of the group.
References
1. Edefonti A, Verrina E, Schaefer F, Fischbach M, Watson A.
The European experience with CAPDuCCPD in children. In:
Fine RN, Alexander SR, Warady BA, eds. CAPDuCCPD
in Children, 2nd Edn. Kluwer Academic Publishers, Boston,
MA, 1998; 17–34
2. National Kidney Foundation NKF-DOQI clinical practice
guidelines for peritoneal dialysis adequacy. Am J Kidney Dis
1997; 30 wSuppl 2x: S67–S136
3. Holtta T, Ronnholm K, Jalanko H, Holmberg C. Clinical
outcome of pediatric patients on peritoneal dialysis under
adequacy control. Pediatr Nephrol 2000; 14: 889–897
4. Schaefer F. Adequacy of peritoneal dialysis in children. In:
Fine RN, Alexander SR, Warady BA, eds. CAPDuCCPD
in Children, 2nd Edn. Kluwer Academic Publishers, Boston,
MA, 1998; 99–118
5. Watson AR, Gartland G on behalf of the European Paediatric
Peritoneal Working Group. Guidelines by an ad hoc European
committee on elective peritoneal dialysis in pediatric patients.
Perit Dial Int 2001; 21: 240–244
6. Morgenstern B. Structure and function of the pediatric
peritoneal membrane. In: Fine RN, Alexander SR, Warady
BA, eds. CAPDuCCPD in Children, 2nd Edn. Kluwer Academic
Publishers, Boston, MA, 1998; 73–86
7. Warady BA, Alexander S, Hossli SR, Vonesh E, Geary D,
Kohaut E. The relationship between intraperitoneal volume and
solute transport in pediatric patients. Peritoneal Dialysis Study
Consortium. J Am Soc Nephrol 1995; 5: 1935–1939
8. Alexander SR, Salusky IB, Warady BA, Watkins SL. Peritoneal
dialysis workshop: pediatrics recommendations. Perit Dial Int
1996; 17 wSuppl 3x: S25–S27
9. Fischbach M, Terzic J, Bergere V, Gaugler C, Provot E. The
optimal approach to peritoneal dialysis prescription in children.
Perit Dial Int 1999; 19: S474–478
10. Kohaut EC, Waldo FB, Benfield MR. The effect of changes
in dialysate volume on glucose and urea equilibration. Perit Dial
Inter 1994; 14: 236–239
11. De Boer AW, Van Schaijk TCJG, Willems HL, Reddingius RE,
Monnens LAH, Schröder CH. The necessity of adjusting
dialysate volume to body surface area in pediatric peritoneal
equilibration tests. Perit Dial Int 1997; 17: 199–202
12. Haraldsson B. Assessing the individual peritoneal dialysis
capacities of individual patients. A clinical tool based on the
three pore model. Kidney Int 1995; 47: 1187–1198
13. Schaefer F, Haraldsson B, Haas S, Simkova E, Feber J,
Mehls O. Estimation of peritoneal mass transport by three
pore model in children. Kidney Int 1998; 54: 1372–1379
14. Fischbach M, Haraldsson B. Dynamic changes of the total pore
area available for peritoneal exchange in children. J Am Soc
Nephrol 2001; 12: 1524–1529
15. Fischbach M, Terzic J, Gaugler C, Bergere V, Munch K,
Hamel G. Impact of an increased intraperitoneal fill volume
both on tolerance and dialysis effectiveness in children. In:
Khanna R, ed. Advances in Peritoneal Dialysis. Peritoneal
Dialysis Publications, Toronto, 1998; 14: 258–264
16. Fischbach M, Terzic J, Gaugler C, Schneider P, Roger ML,
Geisert J. Effect of posture on intraperitoneal pressure
M. Fischbach et al.
and peritoneal permeability in children. Pediatr Nephrol 1998;
12: 311–314
17. Churchill DN, Thorpe KE, Nolph KD, Keshaviah PR,
Oreopoulos DG, Page D. Increased peritoneal membrane trans-
port is associated with decreased patient and technique survival
for continuous peritoneal dialysis patients. The Canada–USA
(CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol
1998; 9: 1285–1292
18. Schaefer F, Klaus G, Mehls O, the Mid European Pediatric
Peritoneal Dialysis Study Group. Peritoneal transport prop-
erties and dialysis dose affect growth and nutritional status
in children on peritoneal dialysis. J Am Soc Nephrol 1999;
10: 1786–1792
19. Malhotra C, Murata GH, Tzamaloukas AH. Creatinine
clearance and urea clearance in PD. What to do in case of
discrepancy. Perit Dial Int 1997; 17: 532–535
20. Aranda RA, Romão JE Jr, Kakehashi E, Domingos W,
Sabbaga E, Mazondes M, Abensur H. Intraperitoneal pressure
and hernias in children on peritoneal dialysis. Pediatr Nephrol
2000; 14: 22–24
Downloaded from http://ndt.oxfordjournals.org/ at Pennsylvania State University on March 4, 2014
21. Fischbach M, Lahlou A, Eyer D, Desprez P, Geisert J.
Peritoneal dialysis prescription for neonates. Perit Dial Int
1996; 16 wSuppl 1x: 10–12
22. Keshaviah P, Emerson PF, Vonesh EF, Brandes JC.
Relationship between body size, fill volume and mass
transfer coefficient in peritoneal dialysis. J Am Soc Nephrol
1994; 4: 1870–1876
23. Fischbach M, Terzic J, Menouer S, Bergere V, Ferjani L,
Haraldsson B. Impact of fill volume changes on peri-
toneal dialysis and tolerance in children. Adv Perit Dial 2000;
16: 320–323
24. Fischbach M, Terzic J, Menouer S, Haraldsson B. Optimal
volume prescription for children on peritoneal dialysis. Perit Dial
Int 2000; 20: 603–606
25. Bouts AH, Davin JC, Groothoff JW, Van Amstil SP,
Zweers MM, Krediet RT. Standard peritoneal permeability
analysis in children. J Am Soc Nephrol 2000; 11: 343–350
26. Verger C, Larpent L, Veniez G. Mathematical determination
of PET. Perit Dial Int 1990; 10 wSuppl 1x: 181–182
27. Verger C. Comment utiliser le péritoine comme membrane
de dialyse? Ne´phrologie 1995; 16: 19–31
28. Krediet RT, Douma CE, Ho Dac et al. Impact of different
dialysis solutes on solute and water transport. Perit Dial Int
1997; 17 wSuppl 2x: S17–S26
29. Reddingius RE, Schröder CH, Willems JL et al. Measurement
of peritoneal fluid handling in children on continuous ambu-
latory peritoneal dialysis using Dextran 70. Nephrol Dial
Transplant 1995; 10: 866–870
30. Pannekeet MM, Krediet RT. The standard peritoneal per-
meability analysis: tool for the assessment of peritoneal
permeability characteristics in CAPD patients. Kidney Int 1995;
48: 866–875
31. Fischbach M, Lalhou A, Eyer D, Desprez P, Geisert J.
Determination of individual ultrafiltration time (APEX) and
purification phosphate time (PPT) by peritoneal equilibration
test (PET). Application to individual peritoneal dialysis modality
prescription in children. Perit Dial Int 1996; 16: S557–S560
32. Reznick VM, Lorr EF, Collins M et al. The acute peritoneal
equilibration test (APEX): optimizing acute peritoneal dialysis
in children. Perit Dial Int 1993; 13: S65
33. Van der Voort JH, Harvey EA, Braj B, Geary DF. Can the
DOQI guidelines be met by peritoneal dailysis alone in pediatric
patients? Pediatr Nephrol 2000; 14: 717–719
34. Diaz-Buxo JA. Enhancement of peritoneal dialysis. The PD plus
concept. Am J Kidney Dis 1996; 27: 92–98
35. Durand PY, Freida P, Issad B, Chanliau J. How to reach
optimal creatinine clearances in automated peritoneal dialysis?
Perit Dial Int 1996; 16 wSuppl 1x: S167–S170
36. Wang T, Heimburger O, Cheng HH, Vaniewski J, Bergström J,
Lindholm B. Effect of increased dialysate fill volume on
peritoneal fluid and solute transport. Kidney Int 1997;
52: 1068–1076
37. Walk TLM, Schröder CH, Reddingius RE, Lelivelt M,
Monnens LAH, Willems HL. Adequate dialysis? Measurement
Paediatric peritoneal dialysis prescription
of KTuV in a pediatric peritoneal dialysis population. Perit Dial
Int 1997; 17: 175–178
38. Nolph KT, Twardowski ZJ, Keshaviah P. Weekly clearances
of urea and creatinine on CAPD and NIPD. Perit Dial Int
1992; 12: 298–303
39. De Boer AW, Schröder CH, Van Vliet R, Willems JL,
Monnens LAH. Clinical experience with icodextrin in children:
ultrafiltration profiles and metabolism. Pediatr Nephrol 2000;
15: 21–24
40. Coleman JE, Edefonti A, Watson AR. Guidelines by an
ad hoc European committee on the assessment of growth and
385
nutritional status in children on chronic peritoneal dialysis.
Perit Dial Int 2001; 21: 323
41. Canepa A, Verrina E, Perfumo F, Carrea A. Menoni S,
Delucchi P, Gusmano R. Value of intraperitoneal amino acids
in children treated with chronic peritoneal dialysis. Perit Dial Int
1999; 19 wSuppl 2x: S435–S440
42. Harvey EA, Brag B, Geary DF, Balfe W. Correlation of
weekly dialytic KtuV and creatinine clearance with total therapy
volume delivered in a pediatric automated peritoneal dialysis
population. Perit Dial Int 1997; 17 wSuppl 1x: S85
Downloaded from http://ndt.oxfordjournals.org/ at Pennsylvania State University on March 4, 2014