Peritoneal dialysis in children should be initiated when CrCl is <10 ml/min per 1.73 m2 and/or when there are symptoms and signs of uremia and/or growth failure.
Double-cuff catheters can be used in children heavier than 3 kg where the external cuff can be placed 2–3 cm from the exit site.
Exit sites should be oriented either downward (preferred) or laterally in children.
Use of a swan neck catheter in children should be left to the discretion of the individual PD center.
Children should have a PD catheter which has a curled intraperitoneal segment.
The tip of the PD catheter should be placed, whenever possible, in the pelvis.
The decision to perform an omentectomy (or omentopexy if a laparoscopic insertion is contemplated) in a pediatric patient should be left to the discretion of the surgeon.
All children should receive preoperative and, when appropriate, postoperative antibiotics with the insertion of a PD catheter.
Timing for the initiation of dialysis post catheter insertion should be left to the discretion of the center recognizing the need for wound healing. If initiation of dialysis is required within 7 days post-catheter insertion, low volumes should be commenced (500 ml/m2 body surface area).
Membrane characteristics should be determined by the PET with a test exchange volume scaled to body surface area (1,100 ml/m2, 2.5% dialysate) and this should then determine a dialysis regimen with optimization of dwell time and exchange volumes.
Delivered PD dose and residual renal function should be measured 1 month after reaching maximum dwell volume and a minimum of two times over the subsequent 6 months. After 6 months, total solute clearance should be measured every 3 months and/or if there have been significant changes in the dialysis prescription and/or in the setting of a recent bout of peritonitis (must wait minimum 4 weeks from peritonitis).