Can Children Do Peritoneal Dialysis?
While end stage renal disease (ESRD) can be challenging for anyone to live with, it can be particularly difficult for children, especially school-age children who are trying to fit in and make friends. Peritoneal dialysis (PD) is a home dialysis option that allows children with ESRD to dialyze at home and lead a more normal, active life while getting treatment for kidney failure.
What is PD?
PD is a form of home dialysis that uses the peritoneal membrane in the abdomen to clean the patient’s blood. During a process known as an exchange, a special solution, called dialysate, is put into the peritoneal cavity through a catheter (small tube) that has been placed in the patient’s abdomen. The dialysate dwells, or stays, in the abdomen for a prescribed period of time. While it dwells, the dialysate absorbs extra fluid and wastes from the blood. When the dwell time is up, the dialysate is drained from the abdomen and takes the extra fluid and wastes with it.
Two types of PD
- Continuous ambulatory peritoneal dialysis (CAPD) – With CAPD, the child and his or her parent or guardian manually perform the exchanges generally four times a day. Draining the spent dialysis from the abdomen and instilling new solution is done by gravity and takes about 30 minutes. The dwell time is also prescribed by the physician and takes several hours.
- Automated peritoneal dialysis (APD) – APD, commonly referred to as continuous cycling peritoneal dialysis (CCPD), requires a cycler machine to automate the filling and draining process of the exchange. Many children prefer this form of PD because it allows most of their dialysis to be performed while they sleep, freeing up the day for school and other activities.
Advantages of PD for children
- Pain-free – One advantage of PD for children is that their blood is cleaned inside their bodies and doesn’t require the use of needles, as is the case with hemodialysis. Many young children who are scared of needles may feel more comfortable doing PD.
- Flexible treatment schedule – PD frees children from an in-center dialysis schedule and makes it possible for them to do their dialysis treatments around their own schedule instead. This allows them to be involved in more activities, go to school regularly and take part in things other children their age are doing.
- No vascular access needed – Children often have small blood vessels, which makes placement of a graft or fistula for hemodialysis more difficult. Smaller-sized PD catheters work well in children, and the treatments are easily customized for kids of all sizes and ages.
- Ease of travel – PD makes it easy for children and families to travel together. PD cyclers are portable, and PD supplies and dialysate can be shipped to any destination in the U.S.
- Fewer dietary restrictions – Because PD is done every day, there are fewer dietary restrictions with PD than with in-center hemodialysis, which is performed only three times per week. This is an important benefit for children who are still growing.
Catheter placement and training for PD
Before a child can begin PD, he or she will need to have a PD catheter surgically placed in his or her abdomen. A catheter is a soft, flexible tube about the length of a ruler and the width of a pencil. During surgery, one end of the catheter will be put into the child’s peritoneal cavity and the other end will come out of a tiny hole in the lower abdomen. Catheter placement surgery is usually done under general anesthesia, and most patients go home the day of the procedure.
When the catheter exit site has healed and the catheter is ready to use for PD, the child and his or her parent or guardian will go through a comprehensive safety and training class at a dialysis clinic to learn how to do PD. The child will take an active part in the training and will be assigned age-appropriate tasks to be done during the treatment. Training will be done by a PD nurse and generally takes about two weeks. As the child gets older and learns more about PD, he or she will be able to take on more of the tasks associated with the child’s treatment.
Choosing PD for your child
PD is an option for children with ESRD that makes it easier for them to maintain an active lifestyle and keep up with children their age. Talk with your child’s doctor today to see if PD is the right dialysis treatment for your child.