Dialyse péritonéale chez l'enfant : Approches physiopathologiques, prescription et gestion des complications pour un traitement adéquat.
DOI :
https://doi.org/10.25796/bdd.v8i2.87081Mots-clés :
dialyse peritoneale, pediatrie, prescription de dialyse, avantages et inconvenients, limites, insuffisance rénaleRésumé
La dialyse péritonéale (DP) est la modalité de suppléance rénale la plus utilisée chez l’enfant dans le monde. Elle utilise la membrane péritonéale comme surface d’échange semi perméable pour les échanges d’eau et de solutés entre le dialysat et les capillaires péritonéaux. Deux techniques principales sont proposées: la dialyse péritonéale continue ambulatoire (DPCA) et la dialyse péritonéale automatisée (DPA).
La prescription pédiatrique doit être individualisée en fonction de la surface corporelle, de la pression intra-péritonéale (PIP) et des besoins spécifiques en dialyse. La DP est générallement bien tolérée et présente plusieurs avantages : une meilleure préservation de la fonction rénale résiduelle, une possibilité de traitement à domicile, un maintien de la scolarité, et l’absence d’anticoagulation. Elle peut toutefois entraîner des complications mécaniques (hernie, fuite, douleurs) et infectieuses (péritonites, infections liées au cathéter) parfois plus fréquentes que chez les adultes.
La pose d’un cathéter adapté (type Tenckhoff) dans des conditions stériles, associée à une prophylaxie antibiotique, est essentielle pour garantir l’efficacité et la sécurité du traitement. L’adéquation de la dialyse en pédiatrie tient compte du choix du soluté (glucose icodextrine, bicarbonate ou lactate), des paramètres de la prescription pour optimiser clearances et volumes, tout en préservant la membrane péritonéale, .mais a également pour but de maintenir la croissance staturo-pondérale normale de l’enfant. La dialyse péritonéale est la technique d’épuration extrarénale de choix pour les enfants d’autant plus pour ceux qui habitent loin des centres d’hémodialyse pédiatrique.
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© ROUBA BECHARA, Bruno Ranchin, Ariane Zaloszyc 2025
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