Chronic peritoneal dialysis in children

Abstract Chronic kidney failure is rare in children and adolescents. The availability and types of kidney replacement therapy (KRT) vary widely, with a global prevalence of 18–100 per million age-related population (pmarp). Approximately 1000 children are on KRT in the UK (prevalence 64.8 pmarp). Almost 25% are on dialysis. Chronic peritoneal dialysis (PD) is the dialysis modality of choice in younger children given its almost universal applicability, cost-effectiveness and the possibility of a home-based treatment. This is most compatible with a child's schooling and social life. Advances in technology have improved outcomes even for the youngest children, but mortality remains high and the morbidity and burden of care should not be underestimated. Optimal management of children on dialysis requires a multidisciplinary team and consideration of the child and family's expectations. With few high-quality randomized trials, clinicians are reliant on prospective cohort studies and international registries to inform and improve management strategies. Children on dialysis have a lifetime of KRT ahead of them. The selection of dialysis modality and management must consider the principles of dialysis access preservation. This review summarizes current epidemiology, principles of dialysis, PD access, modalities, prescriptions and complications of PD, as well as a brief discussion on PD in infants with their unique ethical and technical considerations.