Peritoneal Dialysis Fill Volume for Pediatric Patients
The recommended per kilogram dose of peritoneal dialysis solution for pediatric patients is approximately 30-40 mL/kg, with an instilled volume of at least 1,100 mL/m² body surface area (BSA) being the preferred normalization method. 1
Primary Dosing Recommendation
The initial fill volume should start at 10-20 mL/kg to minimize dialysate leakage risk, with gradual increases to approximately 30-40 mL/kg (800-1,100 mL/m²) as tolerated by the patient. 2
Body surface area (BSA) normalization is strongly preferred over weight-based dosing because peritoneal surface area correlates closely with BSA in an age-independent manner. 1
Individual tolerance must be carefully assessed, as not all patients can accommodate the target volume without complications. 1
Optimal Fill Volume Targets
For children ≥2 years of age, a peak fill volume of 1,400-1,500 mL/m² can be prescribed when considering tolerance, efficiency, and peritoneal membrane recruitment. 3
The minimum recommended instilled volume is at least 1,100 mL/m² for most pediatric patients. 1
Smaller fill volumes (below 1,000-1,100 mL/m²) result in artificially rapid equilibration and the false appearance of increased membrane transport capacity, which can lead to suboptimal prescriptions. 1
Acute Peritoneal Dialysis Considerations
In acute kidney injury settings, the initial fill volume should be limited to 10-20 mL/kg, with gradual increases as tolerated. 2
In neonates and small infants, cycle duration may need reduction to achieve adequate ultrafiltration due to smaller volumes. 2
Close monitoring of total fluid intake and output is mandatory to achieve and maintain normotension and euvolemia. 2
Critical Pitfalls to Avoid
Using weight-based dosing (mL/kg) alone without BSA normalization can result in inadequate dialysis in larger children and excessive volumes in smaller children. 1
Prescribing fill volumes below 1,000 mL/m² during peritoneal equilibration testing (PET) will artificially suggest the patient is a high transporter, leading to inappropriate prescription modifications. 1
Failing to gradually increase fill volume from the initial conservative dose can result in chronically inadequate dialysis delivery. 2
Ignoring individual tolerance factors (intraperitoneal pressure, patient comfort, leak risk) when pushing toward optimal volumes can cause treatment complications. 1, 3
Monitoring and Adjustment Strategy
Intraperitoneal pressure measurement in centimeters of H₂O provides the best clinical control for determining maximum tolerable fill volume. 3
The peritoneal equilibration test (PET) should be performed approximately 1 month following initiation using the standardized exchange volume of 1,000-1,100 mL/m² BSA. 1
Delivered dose should be measured 2-4 weeks following initiation through 24-hour dialysate and urine collection for Kt/Vurea and creatinine clearance calculations. 1
Target delivered PD dose should be a total Kt/Vurea of at least 2.0 per week for CAPD, with creatinine clearance targets of at least 60 L/wk/1.73 m² for high transporters and 50 L/wk/1.73 m² for low transporters. 1