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Pediatric peritoneal dialysis

Less invasive therapy for a more normal life

  • Bridges time to transplantation
  • Easy to perform
  • Less invasive than extracorporeal treatments
  • Does not require anticoagulation
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DISCLAIMER

Not all products and services are cleared or available for sales in all Asia Pacific countries.. Check your country web site for for details. 

Peritoneal dialysis (PD) is in general the preferred treatment modality for paediatric patients to bridge the time until transplantation. It is easier to perform, less invasive than extracorporeal treatments and does not require anticoagulation.

However, what counts most for the child and the family is that PD can be carried out at home. PD is more compatible with a “normal” lifestyle and allows a better psychosocial integration of the little patient.

Fresenius Medical Care offers a comprehensive range of therapy systems adapted to the specific requirements of PD in paediatric patients:

  • PD-Paed Plus
  • sleep•safe
  • balance
  • BCM-Body Composition Monitor
PD-Paed Plus — PD in the smallest patients

Easy-to-use preassembled system 

PD-Paed Plus is designed to perform PD manually in premature babies, neonates and infants. It is an easy-to-use preassembled system for in-center use.

Flexible treatment adaptation
  • Capacity for inflow volumes of up to 240 mL
  • Precise fluid balancing with the combination of an inflow and outflow burette
  • Option to connect two fluid bags at the same time

Safety features give confidence
  • An integrated ball valve in the inflow burette ensures that only the prescribed volume is given to the patient
  • Improved therapeutic efficiency with a low recirculation volume of only 2 ml
  • Our patented PIN technology reduces the number of risk steps associated with disconnection and reconnection1
  • DEHP-free materials ensure biocompatibility

Pre-warmed PD fluid helps to prevent tachycardia and hypotension2:

PD-Paed Plus and the Barkey Warming System XPT are perfectly matched to manage PD fluid temperature efficiently.

sleep•safe – Free days and protected overnight dialysis

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Treatments tailored to young patients
sleep•safe is a reliable and popular device to treat children on automated PD, in general during the night time at home. It stands out for its flexibility to tailor a treatment according to the individual needs of the patient:
Adjustable flow rates for low volume treatments
Special paediatric disposable set for low volumes
Option to perform ‘Adapted APD (aAPD)’ to improve patient outcome by varying dwell time, and fill volume and glucose concentration in one treatment3

 

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All sleep•safe disposables are made of Biofine®, a PVC-free material certified with the Nordic Ecolabel.

sleep•safe is a popular cycler in children of all ages4:

Giving parents the confidence in the treatment and its comfort
Integrated continuous pressure monitoring helps to prevent outflow pain
Quiet operation
Automatic bag connection and PIN technology reduce contamination risk steps to one per day
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  • Total number of pediatric sleep•safe patients: 4474
  • Number of sleep•safe patients in IPPN registry per age group

balance – Biocompatible PD fluids

Experts recommend that biocompatible multi-chambered PD fluids which are low in glucose degradation products (GDP) should become the standard of care for children on PD6. Children dialyzed with biocompatible PD fluid show significant catch-up growth when compared to children on conventional solutions5.

The concentration of glucose degradation products (GDPs) differs considerably. balance show lowest levels of GDPs compared to other biocompatible PD fluids10.

balance – Biocompatible PD fluids

Biocompatible fluids are essential for growth

Biocompatible fluids are essential for growth

Children dialyzed with biocompatible PD fluids grow better than those on conventional PD fluids5

Biocompatible PD fluids are not all the same

Biocompatible PD fluids are not all the same

Other GDPs: Formaldehyde, 5-HMF, 2-Furaldehyde, Glyoxal, Methylglyoxal, Glucosone. (Graph adapted from Himmele et al. PDI 201210

BCM-Body Composition Monitor – Easy treatment optimization

Is the child thriving or fluid overloaded?

Especially in children on dialysis it is not always easy to differentiate between a gain in weight because of growth or because of fluid overload.

 This is where the BCM-Body Composition Monitor helps you to assess the individual hydration and nutritional status of your patient. The device is based on bioimpedance spectroscopy and gives you a clear picture over time of the child’s fluid status and how the lean and fat tissue mass have developed.

  • Accurate and highly reproducible data
  • Based on typical pediatric reference ranges11
  • Easy to apply and non-invasive
  • Validated for children with a body weight of ≥10 kg
  • Easy analysis of data with the Fluid Management Tool (FMT) on a personal computer 

Learn more about the Body Composition Monitor

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Course of body composition and blood pressure over 10 months in a 2-year old PD patient

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1 Fresenius Medical Care internal analysis

2 Warady BA, Morgenstern BZ, Alexander SR. Peritoneal Dialysis. In: Pediatric Nephrology by Avner ED et al. Publishers Lippincott Williams & Wilkins; 5th edition, page 1375-94

3 Fischbach M, Issad B, Dubois V, Taamma R. The beneficial influence on the effectiveness of automated peritoneal dialysis of varying the dwell time (short/long) and fill volume (small/large): randomized controlled trial. Peritoneal Dialysis International 2011; 31(4):450-8.

4 Registry data from the International Pediatric Peritoneal Dialyis Network (IPPN) 2007–2012 (unpublished).
5 Rees L, Azocar M, Borzych D, Watson AR, Büscher A, Edefonti A, Bilge I, Askenazi D, Leozappa G, Gonzales C, van Hoeck K, Secker D, Zurowska A, Rönnholm K, Bouts AHM, Stewart H, Ariceta G, Ranchin B, Warady BA, and Schaefer F, for the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Growth in very young children undergoing chronic peritoneal dialysis. Journal of the American Society of Nephrology 2011; 22: 2303–2312.

6 Schmitt CP, Bakkaloglu SA, Klaus G, Schroeder C, Fischbach M: Solutions for peritoneal dialysis in children: recommendations by the European Pediatric Dialysis Working Group. Pediatric Nephrology 2011; 26(7):1137–47.

7 Feriani M, Kirchgessner J, La Greca G, Passlick-Deetjen J. Randomized long-term evaluation of bicarbonate-buffered CAPD solution. Kidney International 1998;54(5):1731-8.

8 Haas S, Schmitt CP, Arbeiter K, Bonzel KE, Fischbach M, John U, Pieper AK, Schaub TP, Passlick-Deetjen J, Mehls O, Schaefer F: Improved acidosis correction and recovery of mesothelial cell mass with neutral-pH bicarbonate dialysis solution among children undergoing automated peritoneal dialysis.
Journal of the American Society of Nephrology 2003;14:2632–38.

9 Mortier S, De Vriese AS, Van de Voorde J, Schaub TP, Passlick-Deetjen J, Lameire NH. Hemodynamic effects of peritoneal dialysis solutions on the rat peritoneal membrane: role of acidity, buffer choice, glucose concentration, and glucose degradation products. J Am Soc Nephrol 2002;13(2):480-9. Erratum in: Journal of the American Society of Nephrology 2002;13(5):1419-22.

10 Himmele R, Jensen L, Fenn D, Ho C, Sawin D, Diaz–Buxo J. A new neutral-pH low-GDP peritoneal dialysis fluid. Peritoneal Dialysis International 2012;32(4):444-52.

11 Wieskotten S, Knobloch V, Wiemann K, Wabel P, Wühl E, Schäfer F. Use of the BCM—body composition monitor in children – establishing new reference ranges. Pediatric Nephrology 2008; 23:1571–719.