Introduction and history
Introduction
Worldwide, peritoneal dialysis (PD) has long been recognized as the dialysis modality of choice for pediatric end-stage renal disease (ESRD) patients. Not only is the treatment regimen flexible to a variety of family lifestyles and environments; placement of a PD access is usually possible throughout early developmental stages of the lifespan. With infants, hemodialysis (HD), although technically possible, is difficult. Maintenance of a functional and complication-free vascular access can be problematic. The decision to select PD as a dialysis modality for the pediatric patient requires considering several factors including patient size, medical comorbidities, and overall family support.
History
Pediatric PD evolved on the heels of the therapy’s early investigative work within the adult ESRD population. Reports published by Bloxsum and Powell1 in 1948 and Swan and Gordon2 in 1949, describe PD as a treatment option for children with acute renal failure (ARF). Undeterred by embryonic PD technologies, Swan and Gordon employed available resources such as 60-watt light bulbs over the dialysate inflow path to regulate temperature of the dextrose solution. Novel investigative work continued and in 1961, Seger3 and colleagues reported the success of pediatric PD for treatment of ARF. Though successful, treatments were plagued with the repeated insertion and removal of metal catheters. In 1968, Tenckhoff and Schecter4 introduced a safe and permanent catheter which revived interest in PD. Shortly after this innovation, the development of an automated delivery system together with the availability of commercial dialysate revolutionized the ability to perform PD in the home setting. The novel concept of equilibration dialysis transformed PD into a popular, effective, and acceptable form of renal substitution therapy. Continuous ambulatory PD (CAPD) was born providing an appealing alternative to HD. Freedom from needle punctures, reduced dietary and fluid restrictions, and decreased risk of disequilibrium syndrome were recognized as potential benefits of choosing PD as one’s dialysis modality. The first reported use of CAPD in a child was in Toronto in 1978.
References:
1. Bloxsum A, Powell N. The treatment of acute temporary dysfunction of the kidneys by peritoneal irrigation. Pediatrics 1:52-57, 1948
2. Swan H, Gordon HH. Peritoneal lavage in the treatment of anuria in children. Pediatrics 4:586-595, 1949
3. Seger WE, Gibson RK, Rhamy R. Peritoneal dialysis in infants and small children. Pediatrics 27:603-613, 1961
4. Tenckoff H, Schecter H. A bacteriologically safe peritoneal access device. Trans Am Soc Artif Intern Organs 14:181-186, 1968
P/N 101211-01 Rev 00 12/2009