Peritoneal Dialysis in Children: Issues for the 21St Century

sate solutions, as well as in the types of catheters and tubing connections, to diminish the potential for infectious complications. The most successful of these changing technologies has been the Y-configuration used in CAPD, which has made the "flush before fill" technique possible, thus allowing contaminants to be flushed into the drain bag before the patient is filled (1). Several studies have shown decreased peritonitis rates in adult patients treated with CAPD with the introduction of the "flush before fill" technique. In contrast, peritonitis rates have remained consistently higher in pediatric patients compared to adults as shown by various studies (2,3). This outcome has been demonstrated in the adult and pediatric dialysis program at UCLA, in which similar training material and treatment protocols are practiced, but in which the peritonitis rate of the pediatric patients is signifi cantly higher. The reasons for higher peritonitis rates in pediatric patients are not very clear. One factor may be that the vast majority of pediatric patients are treated with APD as compared to CAPD in adults. In APD, the "flush before fill" technique ofCAPD has not been perfected in any of the machines used for APD. Multiple bags of solution may be used and the fluid pathway is complex, with no direct flush to the drain bag before the patient is filled. The development of APD technology that utilizes a true "flush before fill"