ESPN 50th Annual Meeting

ESPN 2017


 
Value of Accelerated Peritoneal Examination time in Pediatric Nocturnal intermittent peritoneal dialysis
MOHAMMED AZAR MOHAMED ANSAR ALI 1

1- KING SAUD BIN ABDUL AZIZ UNIVERSITY
 
Introduction:

Pediatric peritoneal dialysis patients depend on optimal dwell time for ultrafiltration and clearance. In clinical practice, most of the pediatric dialysis patients lack optimal dwell time resulting in suboptimal ultrafiltration.   However, it is possible to lineate appropriate dwell time from the APEX (Accelerated Peritoneal Examination time), derived from a standardized PET (peritoneal equilibration test).  The value of APEX is well recognized and appreciated in adapted peritoneal dialysis (combination sequences of short and long dwells within one peritoneal dialysis session). However, in nocturnal intermittent peritoneal dialysis (NIPD) it may be a potential parameter in maximizing the ultrafiltration. 

 

Material and methods:

 

It is a retrospective cohort study, where peritoneal dialysis details were derived from the digital memory card which is incorporated in the dialysis machine (Fresenius cycler-sleep safe (V2.2X). Both paper chart review (for patient data) and electronic chart review (for lab data) were assessed. 

 

 

Results:

 Out of 15 patients enrolled in our study, mean ultrafiltration significantly improved (p<0.01) after calculated APEX (table 1). The mean (SD) were 189.4 ±44.7. Moreover, mean ultrafiltration remarkably improved (p=0.006) both in low/low-average and high/high-average peritoneal transporters. In relation to clearance, Kt/V did not change (p=0.16) before and after APEX (table 2). The mean (SD) were n=15, 2.1 ± 0.3. whereas in relation to creatinine clearance, significant improvement (p=0.04) noted in our study (table 2). The mean (SD) were n=15, 46.8 ± 7.

 Table 1: Relationship between mean ultrafiltration, Kt/v and CrCl before and after APEX

(N=15) 

             Mean ± sd

p-value

 

 

 

 

 

Mean ultrafiltration after APEX

             189.4 ± 44.7

             <0.001

 

Mean ultrafiltration before APEX

             140.5 ±47.1

 

KT/V (after APEX)

              2.1 ± 0.3

.16

 

KT/V (Before APEX)

     2.2 ± 0.4

 

CrCl (After APEX)

              46.8 ± 7.0

0.04

 

CrCl (Before APEX)

              40.5 ± 7.7

 

Kt/v- measures a change in the concentration of urea; CrCl -creatinine clearance;

APEX -Accelerated Peritoneal Examination time; SD -Standard deviation).

 

 

 

Conclusions:

APEX time in NIPD can be essential in maximizing the ultrafiltration and CrCl especially in patients with low and low-average transporters. Also, APEX gives a valuable support to peritoneal high and high average transporters in optimizing the ultrafiltration