Guidelines by an ad hoc European committee on adequacy of the paediatric peritoneal dialysis prescription

Continuous ambulatory peritoneal dialysis (CAPD) has been used in children since 1978 and was rapidly adopted as a home dialysis method. In more recent years, the availability of reliable and portable machines has increased the usage of automated peritoneal dialysis (APD), which now exceeds the use of CAPD in most western countries [1]. The prescription of APD is based on an assessment of the needs of the patient with monitoring of biochemistry at regular intervals. The age of the child, the residual renal function, the nutritional intake, the acceptability of the regime to the child and family are all part of the assessment. Historically, children were prescribed CAPD on an initial regime of four bag changes a day with fill volumes of 30–50 ml/kg body weight per bag. Dialysis adequacy is a concept introduced in the late 1980s, first in haemodialysis and subsequently in peritoneal dialysis (PD), linking outcomes to adequacy targets. Satisfactory or good dialysis could be viewed as the dose of dialysis below which a significant increase in morbidity and mortality would occur. It should not be confused with optimal dialysis, which is the dose of blood purification beyond which no further improvement in the patient's clinical well‐being can be achieved.