Can the DOQI guidelines be met by peritoneal dialysis alone in pediatric patients?
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DOQI guidelines recommend minimal standards for automated peritoneal dialysis (APD), with a weekly Kt/V of 2.1 and creatinine clearance (CCr) of 63 l/1.73 m2. The purpose of this study was to assess if the DOQI guidelines could be met by dialysis alone in children on PD. Dialysis clearance studies were retrospectively analyzed in 20 pediatric patients on APD, all with a dwell volume of at least 1,000 ml/m2. Mean dialytic Kt/V was 2.0; only 45% had a Kt/V above the recommended 2.1. Mean dialytic CCr was 43.5 l/week per 1.73 m2; only 10% achieved a CCr above the recommended 63 l/week per 1.73 m2. Despite the significant correlation between total therapy volume (TTV) and both Kt/V and CCr, only 2 of 10 patients with a TTV over 10 l/m2 per day reached the target CCr. All patients had currently recommended dwell volumes, therapy times, and nocturnal cycles, but DOQI guidelines were difficult to achieve with dialysis alone. Strict adherence to DOQI guidelines in anephric pediatric PD patients may result in changing dialysis modality. However, without evidence of a correlation between delivered dose of dialysis and improved outcome, adequate dialysis should not be assessed by only measuring Kt/V and CCr.
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