Intraperitoneal pressure measurements in children on peritoneal dialysis: a review and European practice survey

Prescribing an adequate intraperitoneal dialysate volume is essential in peritoneal dialysis (PD) to balance optimal solute and fluid removal against the risk of increased intraperitoneal pressure (IPP) and to prevent increased reabsorption and mechanical complications. Since the description of manual hydrostatic IPP measurement (IPPM) in children in 1996, a few small observational studies in children and adults have provided limited evidence on the acceptable upper limit of IPP and associated complications. We conducted a practice survey across European pediatric dialysis centers, which showed that of the responding 47 centers, 68% routinely perform IPPM, but the frequency, mode of measurement, accepted upper limit of IPP, and interpretation of IPPM results vary considerably. In this narrative review, we present the current knowledge on IPP and the rationale for a standardized three-point IPPM, a prerequisite to obtain valid scientific data on the relation of IPP with patient outcome, e.g., by means of registries and adequately powered prospective studies. To date, the role of IPPM in improving outcomes for children on PD is uncertain. Advanced, continuous IPPM technologies providing precise, large-scale IPP data together with PD efficiency and tolerability data will improve our understanding of the impact of IPP on patient outcomes.