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Pediatric peritoneal dialysis

Peritoneal Dialysis — child with

Less invasive therapy for a more normal life

  • Bridges time to transplantation
  • Easy to perform
  • Less invasive than extracorporeal treatments
  • Does not require anticoagulation
PD in the smallest patients

Peritoneal dialysis (PD) is in general the preferred treatment modality for pediatric patients to bridge the time until transplantation1. It is easier to perform, less invasive than extracorporeal treatments and does not require anticoagulation. However, what counts most for the child and the family is that PD can be carried out at home. Fresenius Medical Care offers a comprehensive range of therapy systems adapted to the specific requirements of PD in pediatric patients:

  • PD-Paed Plus
  • sleep•safe harmony
  • bicaVera and balance
  • BCM-Body Composition Monitor
PD-Paed Plus — PD in the smallest patients
Easy-to-use preassembled system  PD-Paed Plus is designed to perform PD manually in premature babies, neonates and infants. It is an easy-to-use preassembled system for in-center use.
Flexible treatment adaptation
  • Capacity for inflow volumes of up to 200 mL
  • Precise fluid balancing with the combination of an inflow and outflow burette
  • Option to connect two fluid bags at the same time
Safety features give confidence
  • An integrated ball valve in the inflow burette supports that only the prescribed volume is given to the patient
  • The PD-Paed Plus is designed in such a way that the recirculation volume between the patient connector and the Y-piece is only 2ml
  • PIN technology reduces the number of risk steps associated with disconnection and reconnection*
  • Materials of concern avoided - no use of DEHP and latex

*Calculated on basis of a 2 exchanges per day prescription

sleep•safe harmony – Free days and protected nightime dialysis

Father sitting with son on hospital bed
Fresenius Biofine® and Nordic Ecolabel logo

Daily disposables do not contain PVC and DEHP*. PD bags and APD tubing set are made with Biofine.

*except APD drainage options

Treatments tailored to young patients
sleep•safe harmony is a device to treat children on automated PD, in general during the night time at home.
It offers high flexibility to tailor a treatment according to the individual needs of the patient:
Adjustable flow rates for low volume treatments
Special pediatric disposable set for low volumes
Option to perform ‘Adapted APD (aAPD)’ by varying dwell time and fill volume.


Giving parents the option in the treatment and its comfort
Integrated on-device animations guiding through the treatment procedure
Quiet hydraulic pump system enables a good night’s sleep
PIN technology reduces the number of risk steps associated with disconnection and reconnection*

* Calculated on basis of a 4 bag connections per day prescription

bicaVera and balance — Biocompatible PD fluids

Experts recommend that biocompatible multi-chambered PD fluids which are low in glucose degradation products (GDP) should become the standard of care for children on PD2. Children dialyzed with biocom¬patible PD fluid show significant catch-up growth when compared to children on conventional solutions3.

The concentration of glucose degradation products (GDPs) differs considerably. balance and bicaVera show lowest levels of GDPs compared to other biocompatible PD fluids7.

Pure bicarbonate PD fluid - bicaVera

bicaVera is purely bicarbonate-buffered and proven to better correct metabolic acidosis than lactate containing PD fluids 4,5. It is recommended in end stage renal failure2.

Less infusion pain

The use of bicarbonate-buffered PD fluids in comparison to conventional lactate-buffered fluids is associated with lower incidence of infusion pain4 and reduced capillary recruitment2.

Biocompatible fluids are essential for growth

Growth of Children dialyzed with biocompatible PD fluids

Children dialyzed with biocompatible PD fluids grow better than those on conventional PD fluids3.

Biocompatible PD fluids are not all the same

GDP concentrations in PD fluids vary significantly

Other GDPs: Formaldehyde, 5-HMF, 2-Furaldehyde, Glyoxal, Methylglyoxal, Glucosone. (Graph adapted from Himmele et al. PDI 20127


BCM-Body Composition Monitor – Easy treatment optimization

Is the child thriving or fluid overloaded?

Chart of body composition development and blood pressure

External anonymised patient case from Germany

Especially in children on dialysis it is not always easy to differentiate between a gain in weight because of growth or because of fluid overload.

This is where the BCM-Body Composition Monitor helps you to assess the individual hydration and nutritional status of your patient. The device is based on bioimpedance spectroscopy and gives you a clear picture over time of the child’s fluid status and how the lean and fat tissue mass have developed.

  • Accurate and highly reproducible data
  • Based on typical pediatric reference ranges8
  • Easy to apply and non-invasive
  • Validated for children9,10
  • Easy analysis of data with the Fluid Management Tool (FMT) on a personal computer 

Learn more about the Body Composition Monitor

Abbreviated Prescribing Information

Abbreviated Prescribing Information PD fluids
Related content
sleep•safe harmony device

As individual as your patients.

1 KDOQI Clinical Practice recommendations for PD adequacy. Am J Kidney Dis. 2006; 48 Suppl 1:146-158

2 Schmitt CP, Bakkaloglu SA, Klaus G, Schroeder C, Fischbach M: Solutions for peritoneal dialysis in children: recommendations by the European Pediatric Dialysis Working Group. Pediatric Nephrology  2011; 26(7):1137–47, page 1140.

3 Rees L, Azocar M, Borzych D, Watson AR, Büscher A, Edefonti A, Bilge I, Askenazi D, Leozappa G, Gonzales C, van Hoeck K, Secker D, Zurowska A, Rönnholm K, Bouts AHM, Stewart H, Ariceta G, Ranchin B, Warady BA, and Schaefer F, for the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Growth in very young children undergoing chronic peritoneal dialysis. Journal of the American Society of Nephrology 2011; 22: 2303–2312, page 2307

4 Feriani M, Kirchgessner J, La Greca G, Passlick-Deetjen J. Randomized long-term evaluation of bicarbonate-buffered CAPD solution. Kidney International 1998;54(5):1731, 1732.

5 Haas S, Schmitt CP, Arbeiter K, Bonzel KE, Fischbach M, John U, Pieper AK, Schaub TP, Passlick-Deetjen J, Mehls O, Schaefer F: Improved acidosis correction and recovery of mesothelial cell mass with neutral-pH bicarbonate dialysis solution among children undergoing automated peritoneal dialysis. Journal of the American Society of Nephrology 2003;14:2632-38.

6 Mortier S, De Vriese AS, Van de Voorde J, Schaub TP, Passlick-Deetjen J, Lameire NH. Hemodynamic effects of peritoneal dialysis solutions on the rat peritoneal membrane: role of acidity, buffer choice, glucose concentration, and glucose degradation products. J Am Soc Nephrol 2002;13(2):480-9. Erratum in: Journal of the American Society of Nephrology 2002;13(5):1419-22, page 486.

7 Himmele R, Jensen L, Fenn D, Ho C, Sawin D, Diaz–Buxo J. A new neutral-pH low-GDP peritoneal dialysis fluid. Peritoneal Dialysis International 2012;32(4):449.

8 Wieskotten S, Knobloch V, Wiemann K, Wabel P, Wühl E, Schäfer F. Use of the BCM—body composition monitor in children – establishing new reference ranges. Pediatric Nephrology 2008; 23:1571–719.

9 Dasgupta I, Keane D, Lindley E, Shaheen I, Tyerman K, Schaefer F, Wühl E, Müller M, Bosy-Westphal A, Fors H, Dahlgren J, Chamney P, Wabel, P, Moissl U. Validating the use of bioimpedance spectroscopy for assessment of fluid status in children. Pediatric Nephrology (2018) 33:1601–1607.

10 Eng C, Bhowruth D, Mayes M, Stronach, L, Blaauw M, Barber A, Rees L, Shroff R. Assessing the hydration status of children with chronic kidney disease and on dialysis: a comparison of techniques. Nephrol Dial Transplant (2018) 33: 847–855.