Technical aspects and prescription of peritoneal dialysis in children

Since 1978, when continuous ambulatory peritoneal dialysis (CAPD) was first introduced for the treatment of pediatric patients with end-stage renal disease (ESRD), a series of technological improvements have been incorporated into the peritoneal dialysis (PD) procedure. Important improvements have been achieved in the safety and ease of use of the mechanical devices employed in the dialysis procedure, as well as in the dialytic efficacy and biocompatibility of the PD solutions. More recently, a revolution in the fields of electronics and computer science has generated a series of automated delivery systems called “cyclers” that allow great prescription flexibility, as well as the monitoring of therapy results and of patient adherence to the dialysis prescription. Unlike CAPD, in which treatment is truly continuous for 24 h of each day, in automated peritoneal dialysis (APD), treatment is usually limited to only a portion of the 24 h, usually over night. Both CAPD and APD are currently widely used in children around the world.