Abstract
Abnormal mineral metabolism (MM) has profound consequences in uremic children. To evaluate the impact of CAPD on MM we performed 52 serial MT studies (x̄ 9 studies/patient) in 7 children 1 week to 16 yr. old maintained on CAPD from 1 to 18 months.
Net daily peritoneal losses averaged 18±25 mg(range +28 to -58) for Ca, 175±112 mg(-34 to -382) for P, 18±6 mg(-9 to -30) for Mg, 6±4.5 μg (-1 to -15) for 25 OH vitamin D, and 28±20 ng (-1.5 to -58) for 1,25(OH)2 D. Losses of 25 OH and 1,25(OH)2 D represented 41% and 105%, respectively, of the circulating pool. Progressive ↓ of plasma 25 OH D(37 to 22 ng/ml) and 1,25(OH)2D (74 to 17 pg/ml) was noted in 3 pats.; iPTH was readily detectable in peritoneal exchanges (352±265 μlEq/ml) and x̄ serum iPTH ↓ by 30% (394 to 280 μlEq/ml, normal 10 to 90) during x̄ 7 mo. observation. Hypermagnesemia (3.1 mg/dl) normalized (2.2 mg/dl) using low-magnesium dialysate (PD2 DianealR). Serum Ca correlated negatively with Ca MT (r= -0.61, p<0.01) and positively with % decline in serum iPTH (r= 0.81, p=0.05). Serial bone radiographs were mostly unchanged.
Thus, CAPD in children: 1) adequately removes P and Mg; 2) leads to minimal Ca losses; 3) substantially removes PTH but also vitamin D metabolites, and 4) improves hyperparathyroidism and hypermagnesemia.
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Freundlich, M., Zilleruelo, G., Abitbol, C. et al. PERITONEAL MASS TRANSFER (MT) OF MINERALS AND BONE-MODULATING HORMONES IN CHILDREN ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD). Pediatr Res 18 (Suppl 4), 361 (1984). https://doi.org/10.1203/00006450-198404001-01611
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DOI: https://doi.org/10.1203/00006450-198404001-01611