Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Introduction: In clinical practice, most of the pediatric dialysis patients lack optimal dwell time resulting in suboptimal ultrafiltration (UF) and solute clearance. The appropriate dwell time may be possible to delineate from the Accelerated Peritoneal Examination (APEX) time, derived from a standardized peritoneal equilibration test (PET). Objectives: This primary objective of the study aims to determine the utility of APEX time for optimal UF in pediatric patients on nocturnal intermittent peritoneal dialysis (NIPD). The secondary objective is to analyze the Kt/V and creatinine clearance L/week/1.73m2 (CrCl) after approximation of optimal dwell time. Methodology: The study retrospectively analyzed pediatric peritoneal dialysis patients (age range: 1-14 years), from January 2001 to April 2016 followed up at King Abdul Aziz Medical City, Riyadh, Saudi Arabia, Pediatrics Dialysis Unit. This was a retrospective case series based on chart review. Bivariate descriptive analysis was carried out to report the difference in the ultrafiltration before and after the APEX time calculation. Results: A total of 15 pediatric patients were enrolled in the study. The mean UF significantly improved after determining the dwell time based on the calculated APEX time (189.4 ±44.7 ml vs 140.5±47.1 ml, p<0.001). Additionally, the mean UF remarkably improved in both low/low-average and high/high-average peritoneal transporters (p=0.006). By analyzing small molecule clearance (Kt/V, and CrCl) in relation to peritoneal transporters, CrCl significantly improved in low/low average peritoneal transporters (p<0.001) whereas, it deteriorated (p<0.001) in high average peritoneal transporters. On the other side, Kt/V did not vary (p=0.93) between the peritoneal transporters. Conclusion: APEX time in NIPD can be helpful in maximizing the ultrafiltration and CrCl especially in patients with low and low-average transporters. The APEX time also provided valuable input in optimizing the UF in high and high average transporters. Correspondence to: Mohammed Azar, Department of Pediatrics, Division of Nephrology, King Abdulaziz Medical City, King Abdullah Specialized Children Hospital, Mail Code 1940, Riyadh, P. O. Box 22490, Riyadh 11426, Kingdome of Saudi Arabia , Tel: +966-118011111Ext53524, E-mail: [email protected]