Peritoneal transport mechanisms and their application during peritoneal dialysis in children.

Abstract

Introduction - Peritoneal dialysis takes an important place as a treatment modality for children with chronic renal failure. This dialysis modality has important advantages compared to hemodialysis: it allows children of all ages to receive dialysis at home with the subsequent experience of a more normal childhood, and avoids repeated needle punctures other than those needed for drug administration. On the contrary this treatment modality places a significant burden both on the child and his or her caregivers. Peritoneal dialysis also implies that attention has to be paid to the functionality of the peritoneal membrane, because most children will depend on it for a major part of their life. Aim - The aim of the studies presented in this thesis, was to evaluate several issues that might be of use in decreasing the psychosocial and physical burden. Outline - The fluid kinetics of icodextrin in children were studied. Icodextrin is a glucose polymer based dialysis solution, which is more biocompatible than the commonly used glucose-based dialysis solutions. Also the influence of different osmotic agents on the intraperitoneal pressure was studied. Attention was paid to diminish the need of subcutaneous drug administration. Eryhropoietin was administered intraperitoneally instead of subcutaneously and results are presented concerning the maintenance dosage needed. To avoid the toxic effects caused by antibiotic treatment of peritonitis a study was performed to evaluate the effectiveness of the use of a first- and a third generation cephalosporin for the treatment of peritonitis. Gastric emptying was studied to obtain more insight in gastro-enterological complications of peritoneal dialysis in children. Experiences with the non-invasive treatment of peritoneal dialysis catheter obstruction with the use of urokinase are described. Also the use of fibrin glue as a non-invasive treatment option in cases of peritoneal dialysis catheter leakage was evaluated.