Identification of the factors associated with intraperitoneal pressure in children with peritoneal dialysis

Identification of the factors associated with intraperitoneal pressure in children with peritoneal dialysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Identification of the factors associated with intraperitoneal pressure in children with peritoneal dialysis Hao He, Xia Shen, Rui Zhao, Hui Zhang, Fan Liu, XiaoShan Tang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7495432/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : The increased Intraperitoneal Pressure（IPP）is considered the predisposing factor for complications of PD in children, however the research on IPP on peritoneal dialysis patients in China remains limited, particularly in children.This study aim to further determine the relevant factors for increased IPP in children undergoing peritoneal dialysis. Methods: We conducted a retrospective observational study of children under 18 years of age with peritoneal dialysis at Children’s Hospital of Fudan University between May 2019 and June 2024.Patient characteristics,IPV,IPPs were collected.IPPs were measured continuously at different filling volumes.the Univariate analysis and multivariate linear regression were used to assess the risk factor of IPP. Results: A total of 101 cases of children were collected,of which 53(52.5%) cases was male,median age of 6.5(4.02,11)years.at the IPV were 600ml,800ml,1000ml,1200ml and 1400ml,the mean±SD of IPP was 9.82±2.05cmH 2 O,8.76±2.02cmH 2 O,10.86±2.16cmH 2 O,11.95±2.32cmH 2 O,12.98±2.33cmH 2 O.The duration time of PD (B= 0.02, p=0.03),BSA (B=-1.64, p= 0.035),and BMI(B=0.53, p<0.001) are significant factors associated with increased IPP while body weight was significant only in the univariate analysis, this association was no significant after multivariate adjustment. Conclusions: Our study demonstrate the IPP was influenced by multiple factors in PD children.Notably, BMI, BSA, and PD duration were the main independent factors,these finding have significant implication in clinical practice,IPP monitoring as a simple and non-invasive measurement technique,it provides critical insights for clinicians to optimize dialysis prescriptions, thereby refining therapeutic regimens and management strategies for pediatric PD patients. Introduction Peritoneal dialysis (PD) is one of the key renal replacement therapy for children with end stage renal disease [1] , According to IPNA(International Pediatric Nephrology Association, IPNA) report the incidence rate of renal replacement of therapy among children aged 0-19years was approximately 0.2~100.1 cases/million in the world (based on data from 71 countries) and approximately 2 cases/million in China, while the prevalence of PD was estimated 0.6 cases/million [2] . The prescription of PD should be personalized to optimize ultrafiltration and purification of blood solutes, an increase in intraperitoneal volume (IPV) can increase the removal of small solutes by increasing the contact surface of the peritoneal membrane [3] . However, to be optimal fill volume should also be well tolerated, without induction of pain, discomfort [4] , additionally it’s important to note that an increased in fill volume also result in elevated intraperitoneal pressure(IPP),high IPP is considered one of the predisposing factors for complications such as appearance of hernias, leakage, gastroesophageal reflux and enteric peritonitis etc [5,6] , Additionally high IPP adversely affects ultrafiltration and consequently decreases the efficiency of dialysis [6] , Finally With the needs of children’s growth and development ,the body size is changes rapidly, thus it’s necessary to determine the optimal dwell volume by measure IPP. IPP can be measured through direct and indirect method, recently a comparative study was conducted and founded that the IPP measured directly by the PD catheter is equivalent to the intra-abdominal pressure measured indirectly by intravesical catheter [7] . IPP measurement is a simple noninvasive techniques, it can achieved by measured under the atmospheric pressure the height of PD fluid in the PD line as described by DURAND et al [9] ,The DURAND method is always considered the gold standard for intraperitoneal pressure measurement and most wildly used in PD patients. Of noted Betancourt et al [4] Founded that the posture of the patient influence the IPP. The sitting position exhibited the highest IPP among all positions under the same IPV, followed by the upright position and finally the supine, studies also shown that IPP further increasing during natural activity, such as speaking, sneezing, coughing, straining etc [10] . Several studies have attempted to explore the correlational between intraperitoneal pressure and relevant clinical factors, in a single center study, Li et al [11] tried to establish an equation in different intraperitoneal volume to estimating IPP in adult PD patients, Nevertheless, their findings often demonstrate inconsistency. Currently, the research on IPP on peritoneal dialysis patients in China remains limited, Particularly in children. Furthermore, this study encompasses a relatively large sample size. The DURAND method was employed to measure IPP in children with peritoneal dialysis. aiming to further determine the relevant factors of IPP in peritoneal dialysis children. Methods Research detail This study is retrospective observational research and got the approval of Research Ethics Committee of Children’s Hospital of Fudan University.Ethics number:(2024)175,The informed consent of all participants and their parents/caregivers were obtained,the inclusion criteria consisted of: 1)age≤18years;2)diagnosis end stage renal disease and received PD treatment;3) PD duration>1month, the exclusion criteria were as follows:1) exist incomplete/missing data. 2) with severe organ/abdominal injury events . 3) have hernia and leakage etc complications. 4) not cooperate for measurement. IPP measurement We utilized monitoring device to measuring the IPP in children with peritoneal dialysis. The monitoring device was developed by Lu et al [12] , the safety and feasibility has been verified. This device consisted of a three-way stopcock with extension tube, a three-way stopcock, a manometer tube, and a Y system peritoneal dialysis bag. The Durand methods was employed for measurement, during the procedure, the measurements were conducted in the peritoneal dialysis unit by two trained peritoneal dialysis nurses used the DURAND methods [9] . During the measurement, the child was positioned supine in state of quiet, with the midaxillary line serving as the reference point and determine the horizontal position of the measuring device. Connect the de-aired three-way stopcock and extension tube and the three-way stopcock to the Y system peritoneal dialysis bag and manometer tube, ensure that the manometer tube vertical aligned with both zero level of column and axillary midline. IPP was measured continuously at different filling volumes of 400ml, 600ml, 800ml, 1000ml,1200ml and 1400ml. Manometer tube observations were made while maintaining smooth breathing. The IPP during minimum exhalation and maximum IPP during inhalation were recorded and averaged to obtain the IPP pressure value corresponding to each intraperitoneal volume.Meanwhile ,during the measurement,the vital sign was be monitored,such as heart rate,respiratory and oxygen saturation if child shows any discomfort or intolerance,the measurement was terminated immediately. Data collected This study collected data on 101children who received PD from May 2019 to June 2024. the following data were collected from each patient’s medical history records: primary disease, age, sex ,date of PD start, Date of IPP measured, Weight ,Height, Body Mass Index( BMI=weight(kg)/height(m 2 ) , Body Surface Area,IPV and IPP etc. BSA was calculated by Du Bios formula [13] ( BSA= 0.007184*weight(kg) 0.425 *height(cm ) 0.725 ). The Z-scores of weight, height and body mass index(BMI)were calculated (Z=measured data-mean data/standard deviation of data)and convert to reference values based on growth curves for healthy children of the same age and sex as reported by the World Health Organization [1 4 ] . and the values were defined according to WHO standards, the height/length for age below -2 indicate stunted ,the height/length between -2 and 2 means normal range ,Furthermore the weight for age below -2 means underweight, the wight for age between -2 and 2 means normal range , the weight for age above 2 meant high body weight, the BMI for age below -2 meant wasted ,the BMI for age between -2 and 2 meant normal range, the BMI for age above 2 indicated overweight, Once the data collection was completed, the researcher organized the data collected into Excel tables. Patients with missing data were excluded from the analysis. the organized data from these Excel tables were imported into SPSS for analysis. Statistic Analysis Analyses were performed using IBM Statistical Package for the Social Sciences (SPSS) version 25.0 (SPSS, Inc., Chicago, IL,USA).The Kolmogorov-Smirnov test was used to test the normality of the scores obtained from a continuous variable in statistical methods. Patient characteristics were demonstrated as counts with proportions for categorical. Normally distributed data are presented as mean ± standard deviation (SD). Non-parametric data are presented as median and interquartile range (IQR), Comparisons of two groups were performed using the t test, Comparisons of more than two groups were performed using the Kruskal-Wallis H test, To test the relevant factors associated with intraperitoneal pressure, multivariate linear regression modeling was used. The dependent variable was defined as the intraperitoneal pressure at an intraperitoneal volume of 1000 ml/m 2, The variables with a significance level of p < 0.05 in the univariate analysis were collected and included as independent variables in the multivariate linear regression model for further analysis. Results were evaluated at 95% confidence intervals and significance level was set at p < 0.05. Results IPP and Patient Characteristic There were 110 case of PD children collected, but 9 case were excluded from analysis due to incomplete or missing data, Among these,8 cases were terminated because of complaints of abdominal distension and 1 case was halted due to complaints of chest tightness during the perfusion process.results a total of 101 case of PD children included in the analysis. all participants maintained stable vital signs without significant fluctuations during the measurement and underwent automated peritoneal dialysis(APD),with a median(IQR) age of 6.5(4.02,11)years, and median(IQR)duration of peritoneal dialysis of 5(1,15.5)month ,of which 53(52.5%) cases were male, and 48(47.5%) case were female, for the primary disease, there were 26(25.7%) cases were glomerular disease,6(5.9%) cases were polycystic kidney disease,26(25.7%) cases were Congenital Anomalies of the Kidney and urinary tract and 34(33.7%) case were others and unclear, According to weight z score classification criteria, there were 56(55.4%) individuals classified as underweight, 45(44.6%) cases within the normal weight range, In terms of height z score, there were 44(43.6%) individuals classified as stunted, 57(56.4%) cases with normal range, as for BMI z score of children, there were 28(27.7%) children classified wasted,64(63.4%) children were fall into normal range ,9(8.9%) cases were classified overweight, The character of population are described as table 1. Table 1. The differences characteristics of children on Peritoneal Dialysis. Variable N (%) Median （ P25,P75 ） H/t P-Value Age（year） <2 20(19.8%) 12(11.29,13.94) 6.57 a 0.26 2-5 19(18.8%) 12(10.00,13.70) 6-8 26(25.7%) 12.38(11.00,14.13) 9-12 17(16.8%) 11.15(10.70,12.65) 12-15 13(12.9%) 11.35(9.63,13.63) 15-18 6(5.9%) 10.25(9.00,12.45) Gender Male 53(52.5%) 11.5(10.45,13.43) 0.28 0.60 Female 48(47.5%) 12(10.56,13.74) Primary Disease PKD 6(5.9%) 12.50(10.86, 14.63) 4.49 a 0.34 GKD 26(25.7%) 12.33(11.10, 14.00) GD 26(25.7%) 11(9.93, 13.43) CAKUT 9(8.9%) 12(10.65, 13.88) Others 34(33.7%) 11.45(10.15, 13.06) Duration of PD (months) 36m 8(7.9%) 13.38(7.50, 15.03) Weight z score Z<-2 56(55.4%) 11.10±2.07 2.27 b 0.03* -2≤Z≤2 45(44.6%) 12.45±2.40 Height z score Z＜-2 44(43.6%) 11.10±2.21 0.11 b 0.91 -2≤Z≤2 57(56.4%) 12.04±2.41 BMI z score Z＜-2 28(27.7%) 10.45(7.65, 12.3) 19.64 a 0.001** -2≤Z＜2 64(63.4%) 12(11, 13.75) Z>2 9(8.9%) 14.5(14, 16.75) Abbreviations: CAKUT: Congenital Anomalies of the Kidney and Urinary Tract PKD:polycystic kidney disease; GKD: genetic kidney disease GD: glomerular disease a are based on Kruskal-Wallis H test ; b are based on independent samples t test *p value <0.05; **p value<0.01 A univariate analysis shows the relationship between IPP and relevant factors and indicate that there were significant differences in duration of age, BMI for age(p<0.01) and Weight for age(p<0.05) in IPP, The variables with a p -value less than 0.05 were collected and used to study the influence factors for IPP by multivariate liner regression models analyses. Table 2. The various IPP in different IPV IPV (ml) IPP (cmH 2 O) F p 400 8.76±2.02 72.95 <0.001 600 9.83±2.02 800 10.90±2.13 1000 10.02±2.31 1200 12.98±2.33 1400 13.81±2.66 abbreviations: IPV: intraperitoneal volume ; IPP: intraperitoneal pressure Table 2 presents the mean and standard deviation of the IPP for all participants with different IPV, Specifically, with an IPV was 600ml,the IPP mean±SD was 9.82±2.05cmH 2 O,for an IPV was 400ml,the IPP mean±SD was 8.76±2.02cmH 2 O,at an IPV was 800ml,the IPP mean±SD was 10.86±2.16cmH 2 O,at an IPV was 1000ml,the IPP mean±SD was 11.95±2.32cmH 2 O,at an IPV was 1200ml,the IPP mean±SD was 12.98±2.33cmH 2 ,uppon reaching an IPV was 1400ml,the IPP mean±SD was 13.81±2.66cmH 2 O.there was a significant difference in intraperitoneal pressure with different intraperitoneal volume. we founded as intraperitoneal volume increased, there is an indication of a progressive increased in intraperitoneal pressure. Table 3. Influence factors for IPP identified by multivariate liner regression Variable B SE Beta t P 95%CI for B Lower Upper Interception 4.95 1.58 3.14 0.002 1.82 8.09 Duration of PD 0.02 0.01 0.19 2.15 0.03 0.002 0.42 BMI 0.53 0.94 0.55 5.62 <0.001 0.31 0.72 BSA -1.64 0.77 -0.21 -2.14 0.035 -3.16 -0.12 Weight z score<-2 0.137 0.44 -0.03 -0.31 0.76 -1.01 0.74 Abbreviations: BSA: body surface area; BMI: body mass index Table 3 presented the predictor factors of IPP in pediatric PD patient, the results indicates that duration of PD ,BSA ,and BMI are significant factors associated with IPP while body weight was significant only in the univariate analysis, this association was no significant after multivariate adjustment and then we established an equation to predict IPP of peritoneal dialysis children according to multivariate liner regression model, the formula as following: IPP=4.95+BMI*0.53-BSA*1.64+Duration of PD*0.02 Discussion In this study the BMI was found to be a robust positive predictor of IPP (B=0.53, p<0.001), indicating that increased BMI is associated with heightened IPP, This finding is aligns with previous studies [15] , where obesity has been shown to exacerbate intraperitoneal pressure, the mechanism underlying this association likely involves Elevated BMI in PD patients may result in increased abdominal visceral fat, contributing to higher intraperitoneal pressure. The significant association between duration of peritoneal dialysis and IPP (B= 0.02, p=0.03) highlights the progressive nature of peritoneal changes over extended treatment periods. Prolonged peritoneal dialysis has been shown to lead to peritoneal membrane remodeling, characterized by increased fibrosis and sclerosis, resulting in decreased peritoneal compliance and subsequent elevation in intraperitoneal pressure [16] . These structural alterations necessitate vigilant long-term management and periodic re-evaluation of patients undergoing PD to mitigate complications associated with chronic IPP elevation. However Sobrino et al [17] noted that chronic exposure to PD fluids and sustained IPP contribute to these adaptations, potentially stability IPP over time. The negative correlation between BSA and IPP (B=-1.64, p= 0.035) suggests a protective effect conferred by larger BSA, Similar findings have been reported in adults investigating the relationship between BSA and abdominal pressure in PD patients [18] , likely due to a more favorable distribution of intra-abdominal contents that mitigates overall pressure. The inverse relationship underscores the potential of BSA as a modulating factor for IPP, indicating that pediatric patients with greater BSA may possess inherent resilience against the detrimental effects of elevated IPP. Our study further demonstrated the feasibility of IPP measurement in the management of children with peritoneal dialysis, highlighting its potential as a comprehensive tool for monitoring and preventing high IPP related complications, By offering dynamic, real-time, non-invasive measurements of IPP, the capability to promptly identify deviations in IPP for proactive interventions to guide treatment decisions, emphasized the critical role of BMI, the duration of PD, and BSA in managing PD children, providing useful insights for clinicians to monitor and address elevated IPP in at-risk populations,such as adjusting dialysis prescription and formulate nutrition plans to address the underlying factors contributing the elevated IPP . Limitation and future research This study retrospectively collected data from medical history records in the past few years to determine the relationship between IPP and certain relevant factors. Although our study design accounted for multiple confounding variables, there are several limitations remain. Firstly, the reliance on historical records may affect the accuracy and completeness of the data. Additionally, we noted that the sample size in this study is relatively limited, which may reduce the statistical power of the tests so that some observed associations may lack sufficient statistical robustness. According to the WSACS(Word Society Abdominal Compartment Syndrome, WSACS) [19] ,Intra-abdominal hypertension is defined as sustained elevation of IAP≥12mmHg,abdominal compartment syndrome is defined as sustained>20mmHg associated with organ dysfunction failure. Fishbach et al [20] suggested in children below 2 years of age IPP should not above 8~10 cmH 2 O, Otherwise the risk of complications such as hernia and leakage etc increases considerably in infants.Thus it’s necessary to conduct a study to determine the prognostic values of predicting intraperitoneal pressure in the risk of complications in peritoneal dialysis children,Additionally multi-center, large scale, prospective and randomized controlled studies should be conducted in the future to provide better evidence clarify the relationship between IPP and relevant factors and provide valuable insight to developing preventative strategies for elevated IPP. Declarations Data available The data concerning the findings of this study are available from the corresponding author upon reasonable request. Corresponding author Corresponding to Qing Zhou References Warady, B. A., Same, R., Borzych-Duzalka, D.et al. (2024). Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis , 44 (5), 303–364. https://doi.org/10.1177/08968608241274096 IPNA Global Registry For Kidney Replacement Therapy In Children Annual Report. (2018). https://ipna-registry. org/fileadmin/reports/ipna Registry Annual Report 2018.Pdf. Fischbach, M., & Warady, B. A. (2009). Peritoneal dialysis prescription in children: Bedside principles for optimal practice. Pediatric Nephrology (Berlin, Germany) , 24 (9), 1633–1642. https://doi.org/10.1007/s00467-008-0979-7 Betancourt, L., Pico, S., Rojas, E., et al. (2024). Relationship between intraperitoneal pressure and the development of hernias in peritoneal dialysis: Confirmation for the first time of a widely accepted concept. International Urology And Nephrology , 56 (2), 759–765. https://doi.org/10.1007/s11255-023-03663-5 Ma, T., Li, X., Hao, J.,et al .(2024). The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications in peritoneal dialysis patients. Journal of nephrology , 37 (5), 1351–1360. https://doi.org/10.1007/s40620-024-01913-y Leung, K. C., Mahony, S., Brown, E. A., et al. (2024). Factors affecting intraperitoneal pressure (IPP) and its prognostic value in predicting leak risk and gastrointestinal symptoms in adult peritoneal dialysis patients: a systematic review and meta-analysis. Journal of nephrology , 37 (7), 1767–1777. https://doi.org/10.1007/s40620-024-02091-7 Castellanos, L. B., Clemente, E. P., Cabañas, C. B., et al. (2017). Clinical relevance of intraperitoneal pressure in peritoneal dialysis patients. Peritoneal dialysis international : Journal Of The International Society For Peritoneal Dialysis , 37 (5), 562–567. https://doi.org/10.3747/pdi.2016.00267 Al-Hwiesh, A., Al-Mueilo, S., Saeed, I., et al. (2011). Intraperitoneal pressure and intra-abdominal pressure: Are they the same?. Peritoneal Dialysis International : Journal Of The International Society For Peritoneal Dialysis , 31 (3), 315–319. https://doi.org/10.3747/pdi.2010.00057 Durand, P. Y., Chanliau, J., Gamberoni, J., et al. (1992). Routine measurement of hydrostatic intraperitoneal pressure. Advances in peritoneal dialysis. Conference On Peritoneal Dialysis , 8 , 108–112 Pérez Díaz, V., Sanz Ballesteros, S., Hernández García, E.,et al. (2017). Intraperitoneal pressure in peritoneal dialysis. La presión intraperitoneal en diálisis peritoneal. Nefrologia : publicacion oficial de la Sociedad Espanola Nefrologia , 37 (6), 579–586. https://doi.org/10.1016/j.nefro.2017.05.014 Li, X., Ma, T., Hao, J.et al. (2023) Novel equations for estimating intraperitoneal pressure among peritoneal dialysis patients. Clinical kidney journal , 16 (9), 1447–1456. https://doi.org/10.1093/ckj/sfad021 Lu P; Zhou Q; Shen X; et al (2021) Design and application of peritoneal pressure device on peritoneal dialysis children. Nephrology Journal Of China , 37 (4), 341–346. https://doi.org/10.3760/cma.j.cn441217-20200729-00047. Du Bois, D., & Du Bois, E. F. (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition (Burbank, Los Angeles County, Calif.) , 5 (5), 303–313. WHO Multicentre Growth Reference Study Group (2006) Who child growth standards based on length/height, weight and age. Acta Paediatrica (Oslo, Norway : 1992). Supplement , 450 , 76–85. https://doi.org/10.1111/j.1651-2227.2006.tb02378.x Sigogne, M., Kanagaratnam, L, Mora, C., et al. (2020). Identification of the factors associated with intraperitoneal pressure in ADPKD patients treated with peritoneal dialysis. Kidney international reports , 5 (7), 1007–1013. https://doi.org/10.1016/j.ekir.2020.04.012 Suryantoro, S.D, Thaha, M, Sutanto, H., & Firdausa, S. (2023) Current Insights into Cellular Determinants of Peritoneal Fibrosis in Peritoneal Dialysis: A Narrative Review. Journal of clinical medicine , 12 (13), 4401. https://doi.org/10.3390/jcm12134401 Sobrino-Pérez, A., Pérez-Escudero, A., Fernández-Arroyo, L. et al (2021) Intraperitoneal pressure: Stability over time and validation of Durand's measurement method. Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis , 41 (4), 427–431. https://doi.org/10.1177/0896860820973120 de Jesús Ventura, M, Amato, D, Correa-Rotter, R, et al. (2000) Relationship between fill volume, intraperitoneal pressure, body size, and subjective discomfort perception in CAPD patients. Mexican Nephrology Collaborative Study Group. Peritoneal dialysis international: journal of the International Society for Peritoneal Dialysis , 20 (2), 188–193. Kirkpatrick, A. W, Roberts, D. J, De Waele, J, et al. (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive care medicine , 39 (7), 1190–1206. https://doi.org/10.1007/s00134-013-2906-z Fischbach, M, Terzic, J, Provot, E, Weiss, L, Bergere, et al. (2003) Intraperitoneal pressure in children: fill-volume related and impacted by body mass index. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 23(4), 391–394. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7495432","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":510389960,"identity":"3e3ff6a8-16ff-4e10-abae-b559f7e638b1","order_by":0,"name":"Hao 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19:26:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":548128,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7495432/v1/01249060-36ce-4d09-8add-fa7b1d8dca3c.pdf"},{"id":91057689,"identity":"29b8f123-1ee3-4817-bdf8-798e5e790df9","added_by":"auto","created_at":"2025-09-11 08:14:12","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":600128,"visible":true,"origin":"","legend":"","description":"","filename":"WechatIMG69.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7495432/v1/7ea3a302846b3b79b6088086.jpg"}],"financialInterests":"","formattedTitle":"Identification of the factors associated with intraperitoneal pressure in children with peritoneal dialysis","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePeritoneal dialysis (PD) is one of the key renal replacement therapy for children with end stage renal disease\u003csup\u003e[1]\u003c/sup\u003e, According to IPNA(International Pediatric Nephrology Association, IPNA) report the incidence rate of renal replacement of therapy among children aged 0-19years was approximately 0.2~100.1 cases/million in the world (based on data from 71 countries) and approximately 2 cases/million in China, while the prevalence of PD was estimated 0.6 cases/million\u003csup\u003e[2]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe prescription of PD should be personalized to optimize ultrafiltration and purification of blood solutes, an increase in intraperitoneal volume (IPV) can increase the removal of small solutes by increasing the contact surface of the peritoneal membrane\u003csup\u003e[3]\u003c/sup\u003e. However, to be optimal fill volume should also be well tolerated, without induction of pain, discomfort\u003csup\u003e[4]\u003c/sup\u003e, additionally it’s important to note that an increased in fill volume also result in elevated intraperitoneal pressure(IPP),high IPP is considered one of the predisposing factors for complications such as appearance of hernias, leakage, gastroesophageal reflux and enteric peritonitis\u0026nbsp;etc\u003csup\u003e[5,6]\u003c/sup\u003e, Additionally high IPP adversely affects ultrafiltration and consequently decreases the efficiency of dialysis\u003csup\u003e[6]\u003c/sup\u003e, Finally With the needs of children’s growth and development ,the body size is changes rapidly, thus it’s necessary to determine the optimal dwell volume by measure IPP.\u003c/p\u003e\n\u003cp\u003eIPP can be measured through direct and indirect method, recently a comparative study was conducted and founded that the IPP measured directly by the PD catheter is equivalent to the intra-abdominal pressure measured indirectly by intravesical catheter\u003csup\u003e[7]\u003c/sup\u003e. IPP measurement is a simple noninvasive techniques, it can achieved by measured under the atmospheric pressure the height of PD fluid in the PD line as described by DURAND et al\u003csup\u003e[9]\u003c/sup\u003e ,The DURAND method is always considered the gold standard for intraperitoneal pressure measurement and most wildly used in PD patients. Of noted Betancourt et al\u003csup\u003e[4]\u003c/sup\u003e Founded that the posture of the patient influence the IPP. The sitting position exhibited the highest IPP among all positions under the same IPV, followed by the upright position and finally the supine, studies also shown that IPP further increasing during natural activity, such as speaking, sneezing, coughing, straining etc\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSeveral studies have attempted to explore the correlational between intraperitoneal pressure and relevant clinical factors, in a single center study, Li et al\u0026nbsp;\u003csup\u003e[11]\u003c/sup\u003etried to establish an equation in different intraperitoneal volume to estimating IPP in adult PD patients, Nevertheless, their findings often demonstrate inconsistency. Currently, the research on IPP on peritoneal dialysis patients in China remains limited, Particularly in children. Furthermore, this study encompasses a relatively large sample size. The DURAND method was employed to measure IPP in children with peritoneal dialysis. aiming to further determine the relevant factors of IPP in peritoneal dialysis children.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eResearch detail\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is retrospective observational research and got the approval of Research Ethics Committee of Children’s Hospital of Fudan University.Ethics number:(2024)175,The informed consent of all participants and their parents/caregivers were obtained,the inclusion criteria consisted of: 1)age≤18years;2)diagnosis end stage renal disease and received PD treatment;3) PD duration\u0026gt;1month, the exclusion criteria were as follows:1) exist incomplete/missing data. 2) with severe organ/abdominal injury events . 3) have hernia and leakage etc complications. 4) not cooperate for measurement.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIPP measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe utilized monitoring device to measuring the IPP in children with peritoneal dialysis. The monitoring device was developed by Lu et al\u003csup\u003e[12]\u003c/sup\u003e, the safety and feasibility has been verified. This device consisted of a three-way stopcock with extension tube, a three-way stopcock, a manometer tube, and a Y system peritoneal dialysis bag. The Durand methods was employed for measurement, during the procedure, the measurements were conducted in the peritoneal dialysis unit by two trained peritoneal dialysis nurses used the DURAND methods\u003csup\u003e[9]\u003c/sup\u003e.\u0026nbsp;During the measurement, the child was positioned\u0026nbsp;supine\u0026nbsp;in state of\u0026nbsp;quiet, with the midaxillary line serving as the reference point\u0026nbsp;and\u0026nbsp;determine the horizontal position of the measuring device.\u0026nbsp;Connect the de-aired three-way stopcock and extension tube and the three-way stopcock to the Y system peritoneal dialysis bag and manometer tube, ensure\u0026nbsp;that the\u0026nbsp;manometer tube\u0026nbsp;vertical aligned with both zero\u0026nbsp;level of column\u0026nbsp;and axillary midline.\u0026nbsp;IPP\u0026nbsp;was measured\u0026nbsp;continuously\u0026nbsp;at different filling volumes of 400ml, 600ml, 800ml, 1000ml,1200ml\u0026nbsp;and 1400ml.\u0026nbsp;Manometer tube\u0026nbsp;observations were made while maintaining smooth breathing. The\u0026nbsp;IPP\u0026nbsp;during\u0026nbsp;minimum\u0026nbsp;exhalation and maximum\u0026nbsp;IPP\u0026nbsp;during inhalation were recorded and averaged to obtain the\u0026nbsp;IPP\u0026nbsp;pressure value corresponding to each\u0026nbsp;intraperitoneal\u0026nbsp;volume.Meanwhile ,during the measurement,the vital sign was be monitored,such as heart rate,respiratory and oxygen saturation if child shows any discomfort or intolerance,the measurement was terminated immediately.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collected\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study collected data on 101children who received PD from May 2019 to June 2024. the following data were collected from each patient’s medical history records: primary disease, age, sex ,date of PD start, Date of IPP measured, Weight ,Height, Body Mass Index(\u003cem\u003eBMI=weight(kg)/height(m\u003csup\u003e2\u003c/sup\u003e)\u003c/em\u003e, Body Surface Area,IPV and IPP etc. BSA was calculated by Du Bios formula\u0026nbsp;\u003csup\u003e[13]\u003c/sup\u003e(\u003cem\u003eBSA=\u0026nbsp;0.007184*weight(kg)\u003csup\u003e0.425\u003c/sup\u003e*height(cm\u003c/em\u003e)\u003cem\u003e\u003csup\u003e0.725\u003c/sup\u003e\u003c/em\u003e).\u0026nbsp;The Z-scores\u0026nbsp;of weight, height and body mass index(BMI)were\u0026nbsp;calculated\u0026nbsp;(Z=measured data-mean data/standard deviation of data)and\u0026nbsp;convert\u0026nbsp;to reference values based on growth curves for healthy children of the same age and sex as reported by the World Health Organization\u003csup\u003e[1\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u0026nbsp;and the values were defined according to WHO standards, the height/length for age below -2 indicate stunted ,the height/length between -2 and 2 means normal range ,Furthermore the weight for age below -2 means underweight, the wight for age between -2 and 2 means normal range , the weight for age above 2 meant high body weight, the BMI for age below -2 meant wasted ,the BMI for age between -2 and 2 meant normal range, the BMI for age above 2 indicated overweight,\u0026nbsp;Once the data collection was completed, the researcher organized the data collected into Excel tables.\u0026nbsp;Patients with missing data were excluded from the analysis.\u0026nbsp;the organized data from these Excel tables were imported into SPSS for analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistic Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalyses were performed using IBM Statistical Package for the Social Sciences (SPSS) version 25.0 (SPSS, Inc., Chicago, IL,USA).The Kolmogorov-Smirnov test was used to test the normality of the scores obtained from a continuous variable in statistical methods. Patient characteristics were demonstrated as counts with proportions for categorical.\u0026nbsp;Normally distributed data are presented as mean\u0026nbsp;±\u0026nbsp;standard deviation (SD). Non-parametric data are presented as median and interquartile range (IQR),\u0026nbsp;Comparisons of two groups were performed using the\u0026nbsp;t\u0026nbsp;test,\u0026nbsp;Comparisons of more than two groups were performed using the Kruskal-Wallis H\u0026nbsp;test, To test the relevant factors associated with intraperitoneal pressure,\u0026nbsp;multivariate linear\u0026nbsp;regression modeling\u0026nbsp;was used.\u0026nbsp;The dependent variable was defined as the intraperitoneal pressure at an intraperitoneal volume of 1000 ml/m\u003csup\u003e2,\u003c/sup\u003e The variables with a significance level of p \u0026lt; 0.05 in the univariate analysis were\u0026nbsp;collected\u0026nbsp;and included as independent variables in the multivariate\u0026nbsp;linear regression model for further\u0026nbsp;analysis.\u0026nbsp;Results were evaluated at 95% confidence intervals and significance\u0026nbsp;level\u0026nbsp;was set at \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eIPP and Patient Characteristic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 110 case of PD children collected, but 9 case were excluded from analysis due to incomplete or missing data,\u0026nbsp;Among these,8 cases were terminated \u0026nbsp;because of complaints of abdominal distension and 1 case was halted due to complaints of chest tightness during the perfusion process.results a total of 101 case of PD children included in the analysis. all participants maintained\u0026nbsp;stable vital signs without significant fluctuations\u0026nbsp;during the measurement and\u0026nbsp;underwent automated peritoneal dialysis(APD),with a median(IQR) age of 6.5(4.02,11)years, and median(IQR)duration of peritoneal dialysis of 5(1,15.5)month ,of which 53(52.5%) cases were male, and 48(47.5%) case were female, for the primary disease, there were 26(25.7%) cases were glomerular disease,6(5.9%) cases were\u0026nbsp;polycystic kidney disease,26(25.7%) cases were\u0026nbsp;Congenital Anomalies of the Kidney and\u0026nbsp;urinary\u0026nbsp;tract\u0026nbsp;and 34(33.7%) case were others and unclear,\u0026nbsp;According to\u0026nbsp;weight z score\u0026nbsp;classification criteria, there were\u0026nbsp;56(55.4%)\u0026nbsp;individuals classified as underweight,\u0026nbsp;45(44.6%)\u0026nbsp;cases\u0026nbsp;within the normal weight range,\u0026nbsp;In terms of height\u0026nbsp;z score, there were\u0026nbsp;44(43.6%)\u0026nbsp;individuals classified as stunted,\u0026nbsp;57(56.4%) cases\u0026nbsp;with normal\u0026nbsp;range,\u0026nbsp;as for BMI z score of children, there were 28(27.7%) children classified wasted,64(63.4%) children were fall into normal range ,9(8.9%) cases were classified\u0026nbsp;overweight,\u0026nbsp;The character of population are described as table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. The differences characteristics of children on Peritoneal Dialysis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eVariable\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eMedian\u003c/em\u003e\u003cem\u003e（\u003c/em\u003e\u003cem\u003eP25,P75\u003c/em\u003e\u003cem\u003e）\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eH/t\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP-Value\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eAge（year）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e20(19.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(11.29,13.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e6.57\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2-5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e19(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(10.00,13.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6-8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26(25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.38(11.00,14.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9-12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e17(16.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.15(10.70,12.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12-15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13(12.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.35(9.63,13.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e15-18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.25(9.00,12.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e53(52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.5(10.45,13.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e48(47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(10.56,13.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003ePrimary Disease\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e6(5.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.50(10.86, 14.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e4.49\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGKD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26(25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.33(11.10, 14.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eGD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e26(25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11(9.93, 13.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eCAKUT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9(8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(10.65, 13.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e34(33.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.45(10.15, 13.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eDuration of PD (months)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;12m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e65(64.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(10.93, 13.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e8.17\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.02*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12-36m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28(27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.98(9.69, 12.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026gt;36m\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8(7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e13.38(7.50, 15.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eWeight z score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eZ\u0026lt;-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e56(55.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.10±2.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e2.27\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.03*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-2≤Z≤2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e45(44.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.45±2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eHeight z score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eZ＜-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e44(43.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e11.10±2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.11\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-2≤Z≤2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e57(56.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12.04±2.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eBMI z score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eZ＜-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e28(27.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e10.45(7.65, 12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e19.64\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e0.001**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-2≤Z＜2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e64(63.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e12(11, 13.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eZ\u0026gt;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e9(8.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e14.5(14, 16.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: CAKUT:\u0026nbsp;\u003c/em\u003e\u003cem\u003eCongenital Anomalies of the Kidney and Urinary Tract\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePKD:polycystic kidney disease; GKD: genetic kidney disease GD: glomerular disease\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003csup\u003ea\u003c/sup\u003e\u003c/em\u003e\u003cem\u003e\u0026nbsp;are based on Kruskal-Wallis H test ;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u003csup\u003eb\u0026nbsp;\u003c/sup\u003e\u003c/em\u003e\u003cem\u003eare based on independent samples t test\u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e*p value \u0026lt;0.05; **p value\u0026lt;0.01\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA univariate analysis shows the relationship between IPP and relevant factors and indicate that there were significant differences\u0026nbsp;in duration of age, BMI for age(p\u0026lt;0.01) and Weight for age(p\u0026lt;0.05) in IPP,\u0026nbsp;The variables with a \u003cem\u003ep\u003c/em\u003e-value less than 0.05\u0026nbsp;were collected and used to study the\u0026nbsp;influence\u0026nbsp;factors for\u0026nbsp;IPP\u0026nbsp;by multivariate\u0026nbsp;liner\u0026nbsp;regression\u0026nbsp;models analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. The various IPP in different IPV\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eIPV (ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eIPP (cmH\u003csub\u003e2\u003c/sub\u003eO)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8.76±2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e72.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"6\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9.83±2.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.90±2.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.02±2.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.98±2.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e1400\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13.81±2.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eabbreviations: IPV: intraperitoneal volume ; IPP: intraperitoneal pressure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents the mean and standard deviation of the IPP for all participants with different IPV, Specifically, with an IPV was 600ml,the IPP mean±SD was 9.82±2.05cmH\u003csub\u003e2\u003c/sub\u003eO,for an IPV was 400ml,the IPP mean±SD was 8.76±2.02cmH\u003csub\u003e2\u003c/sub\u003eO,at an IPV was 800ml,the IPP mean±SD was 10.86±2.16cmH\u003csub\u003e2\u003c/sub\u003eO,at an IPV was 1000ml,the IPP mean±SD was 11.95±2.32cmH\u003csub\u003e2\u003c/sub\u003eO,at an IPV was 1200ml,the IPP mean±SD was 12.98±2.33cmH\u003csub\u003e2\u003c/sub\u003e,uppon reaching an IPV was 1400ml,the IPP mean±SD was 13.81±2.66cmH\u003csub\u003e2\u003c/sub\u003eO.there was a significant difference in intraperitoneal pressure with different intraperitoneal volume. we founded as intraperitoneal volume increased, there is an indication of a progressive increased in intraperitoneal pressure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Influence factors for IPP identified by multivariate liner regression\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95%CI for B\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eUpper\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eInterception\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e4.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e1.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e8.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eDuration of PD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e2.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eBSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWeight z score\u0026lt;-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e-1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eAbbreviations: BSA: body surface area; BMI: body mass index\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presented the predictor factors of IPP in pediatric PD patient, the results indicates that duration of PD ,BSA ,and BMI are significant factors associated with IPP while body weight was significant only in the univariate analysis, this association was no significant after multivariate adjustment and then we established an equation to predict IPP of peritoneal dialysis children according to multivariate liner regression model, the formula as following: IPP=4.95+BMI*0.53-BSA*1.64+Duration of PD*0.02 \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study the BMI was found to be a robust positive predictor of IPP (B=0.53, p\u0026lt;0.001), indicating that increased BMI is associated with heightened IPP, This finding is aligns with previous studies\u003csup\u003e[15]\u003c/sup\u003e, where obesity has been shown to exacerbate intraperitoneal pressure, the mechanism underlying this association likely involves\u0026nbsp;Elevated BMI in PD patients may result in increased abdominal visceral fat, contributing to higher intraperitoneal pressure.\u003c/p\u003e\n\u003cp\u003eThe significant association between duration of peritoneal dialysis and IPP (B= 0.02, p=0.03) highlights the progressive nature of peritoneal changes over extended treatment periods. Prolonged peritoneal dialysis has been shown to lead to peritoneal membrane remodeling, characterized by increased fibrosis and sclerosis, resulting in decreased peritoneal compliance and subsequent elevation in intraperitoneal pressure\u003csup\u003e[16]\u003c/sup\u003e. These structural alterations necessitate vigilant long-term management and periodic re-evaluation of patients undergoing PD to mitigate complications associated with chronic IPP elevation. However\u0026nbsp;Sobrino\u0026nbsp;et al\u003csup\u003e[17]\u003c/sup\u003e noted that chronic exposure to PD fluids and sustained IPP contribute to these adaptations, potentially stability IPP over time.\u003c/p\u003e\n\u003cp\u003eThe negative correlation between BSA and IPP (B=-1.64, p= 0.035) suggests a protective effect conferred by larger BSA, Similar findings have been reported in adults investigating the relationship between BSA and abdominal pressure in PD patients\u003csup\u003e[18]\u003c/sup\u003e, likely due to a more favorable distribution of intra-abdominal contents that mitigates overall pressure. The inverse relationship underscores the potential of BSA as a modulating factor for IPP, indicating that pediatric patients with greater BSA may possess inherent resilience against the detrimental effects of elevated IPP.\u003c/p\u003e\n\u003cp\u003eOur study further demonstrated the feasibility of IPP measurement in the management of children with peritoneal dialysis,\u0026nbsp;highlighting its potential as a comprehensive tool for monitoring and preventing high IPP related complications,\u0026nbsp;By offering dynamic, real-time, non-invasive measurements of\u0026nbsp;IPP, the capability to promptly identify deviations\u0026nbsp;in\u0026nbsp;IPP\u0026nbsp;for proactive interventions to guide treatment decisions, emphasized\u0026nbsp;the critical role of BMI, the duration of PD, and BSA in managing PD children, providing useful insights for clinicians to monitor and address elevated IPP in at-risk populations,such as adjusting dialysis prescription and formulate nutrition plans to address the underlying factors contributing the elevated IPP .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation and future research\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study retrospectively collected data from medical history records in the past few years to determine the relationship between IPP and certain relevant factors. Although our study design accounted for multiple confounding variables, there are several limitations remain. Firstly, the reliance on historical records may affect the accuracy and completeness of the data. Additionally, we noted that the sample size in this study is relatively limited, which may reduce the statistical power of the tests so that some observed associations may lack sufficient statistical robustness. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;According to the WSACS(Word Society Abdominal Compartment Syndrome, WSACS)\u0026nbsp;\u003csup\u003e[19]\u003c/sup\u003e,Intra-abdominal hypertension is defined as sustained elevation of IAP≥12mmHg,abdominal compartment syndrome is defined as sustained\u0026gt;20mmHg associated with organ dysfunction failure. Fishbach et al\u003csup\u003e[20]\u003c/sup\u003esuggested in children below 2 years of age IPP should not above 8~10 cmH\u003csub\u003e2\u003c/sub\u003eO, Otherwise the risk of complications such as hernia and leakage etc increases considerably in infants.Thus it’s necessary to conduct a study to determine the prognostic values of predicting intraperitoneal pressure in the risk of complications in peritoneal dialysis children,Additionally multi-center, large scale, prospective and randomized controlled studies should be conducted in the future to provide better evidence clarify the relationship between IPP and relevant factors and provide valuable insight to developing preventative strategies for elevated IPP.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData available\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data concerning the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorresponding to Qing Zhou\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWarady, B. A., Same, R., Borzych-Duzalka, D.et al. (2024). Clinical practice guideline for the prevention and management of peritoneal dialysis associated infections in children: 2024 update. \u003cem\u003ePeritoneal dialysis international : journal of the International Society for Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e44\u003c/em\u003e(5), 303\u0026ndash;364. https://doi.org/10.1177/08968608241274096\u003c/li\u003e\n\u003cli\u003eIPNA Global Registry For Kidney Replacement Therapy In Children Annual Report. (2018). https://ipna-registry. org/fileadmin/reports/ipna Registry Annual Report 2018.Pdf.\u003c/li\u003e\n\u003cli\u003eFischbach, M., \u0026amp; Warady, B. A. (2009). Peritoneal dialysis prescription in children: Bedside principles for optimal practice. \u003cem\u003ePediatric Nephrology (Berlin, Germany)\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(9), 1633\u0026ndash;1642. https://doi.org/10.1007/s00467-008-0979-7\u003c/li\u003e\n\u003cli\u003eBetancourt, L., Pico, S., Rojas, E., et al. (2024). Relationship between intraperitoneal pressure and the development of hernias in peritoneal dialysis: Confirmation for the first time of a widely accepted concept. \u003cem\u003eInternational Urology And Nephrology\u003c/em\u003e, \u003cem\u003e56\u003c/em\u003e(2), 759\u0026ndash;765. https://doi.org/10.1007/s11255-023-03663-5\u003c/li\u003e\n\u003cli\u003eMa, T., Li, X., Hao, J.,et al .(2024). The prognostic values of estimating intraperitoneal pressure in the occurrence of abdominal wall complications in peritoneal dialysis patients. \u003cem\u003eJournal of nephrology\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(5), 1351\u0026ndash;1360. https://doi.org/10.1007/s40620-024-01913-y\u003c/li\u003e\n\u003cli\u003eLeung, K. C., Mahony, S., Brown, E. A., et al. (2024). Factors affecting intraperitoneal pressure (IPP) and its prognostic value in predicting leak risk and gastrointestinal symptoms in adult peritoneal dialysis patients: a systematic review and meta-analysis. \u003cem\u003eJournal of nephrology\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(7), 1767\u0026ndash;1777. https://doi.org/10.1007/s40620-024-02091-7\u003c/li\u003e\n\u003cli\u003eCastellanos, L. B., Clemente, E. P., Caba\u0026ntilde;as, C. B., et al. (2017). Clinical relevance of intraperitoneal pressure in peritoneal dialysis patients. \u003cem\u003ePeritoneal dialysis international : Journal Of The International Society For Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(5), 562\u0026ndash;567. https://doi.org/10.3747/pdi.2016.00267\u003c/li\u003e\n\u003cli\u003eAl-Hwiesh, A., Al-Mueilo, S., Saeed, I., et al. (2011). Intraperitoneal pressure and intra-abdominal pressure: Are they the same?. \u003cem\u003ePeritoneal Dialysis International : Journal Of The International Society For Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e31\u003c/em\u003e(3), 315\u0026ndash;319. https://doi.org/10.3747/pdi.2010.00057\u003c/li\u003e\n\u003cli\u003eDurand, P. Y., Chanliau, J., Gamberoni, J., et al. (1992). Routine measurement of hydrostatic intraperitoneal pressure. \u003cem\u003eAdvances in peritoneal dialysis. Conference On Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e8\u003c/em\u003e, 108\u0026ndash;112\u003c/li\u003e\n\u003cli\u003e P\u0026eacute;rez D\u0026iacute;az, V., Sanz Ballesteros, S., Hern\u0026aacute;ndez Garc\u0026iacute;a, E.,et al. (2017). Intraperitoneal pressure in peritoneal dialysis. La presi\u0026oacute;n intraperitoneal en di\u0026aacute;lisis peritoneal. \u003cem\u003eNefrologia : publicacion oficial de la Sociedad Espanola Nefrologia\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e(6), 579\u0026ndash;586. https://doi.org/10.1016/j.nefro.2017.05.014\u003c/li\u003e\n\u003cli\u003e Li, X., Ma, T., Hao, J.et al. (2023) Novel equations for estimating intraperitoneal pressure among peritoneal dialysis patients. \u003cem\u003eClinical kidney journal\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(9), 1447\u0026ndash;1456. https://doi.org/10.1093/ckj/sfad021\u003c/li\u003e\n\u003cli\u003e Lu P; Zhou Q; Shen X; et al (2021) Design and application of peritoneal pressure device on peritoneal dialysis children. \u003cem\u003eNephrology Journal Of China\u003c/em\u003e, \u003cem\u003e37\u003c/em\u003e (4), 341\u0026ndash;346. https://doi.org/10.3760/cma.j.cn441217-20200729-00047.\u003c/li\u003e\n\u003cli\u003e Du Bois, D., \u0026amp; Du Bois, E. F. (1989) A formula to estimate the approximate surface area if height and weight be known. 1916. \u003cem\u003eNutrition (Burbank, Los Angeles County, Calif.)\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(5), 303\u0026ndash;313.\u003c/li\u003e\n\u003cli\u003e WHO Multicentre Growth Reference Study Group (2006) Who child growth standards based on length/height, weight and age. \u003cem\u003eActa Paediatrica (Oslo, Norway : 1992). Supplement\u003c/em\u003e, \u003cem\u003e450\u003c/em\u003e, 76\u0026ndash;85. https://doi.org/10.1111/j.1651-2227.2006.tb02378.x\u003c/li\u003e\n\u003cli\u003e Sigogne, M., Kanagaratnam, L, Mora, C., et al. (2020). Identification of the factors associated with intraperitoneal pressure in ADPKD patients treated with peritoneal dialysis. \u003cem\u003eKidney international reports\u003c/em\u003e, \u003cem\u003e5\u003c/em\u003e(7), 1007\u0026ndash;1013. https://doi.org/10.1016/j.ekir.2020.04.012\u003c/li\u003e\n\u003cli\u003e Suryantoro, S.D, Thaha, M, Sutanto, H., \u0026amp; Firdausa, S. (2023) Current Insights into Cellular Determinants of Peritoneal Fibrosis in Peritoneal Dialysis: A Narrative Review. \u003cem\u003eJournal of clinical medicine\u003c/em\u003e, \u003cem\u003e12\u003c/em\u003e(13), 4401. https://doi.org/10.3390/jcm12134401\u003c/li\u003e\n\u003cli\u003e Sobrino-P\u0026eacute;rez, A., P\u0026eacute;rez-Escudero, A., Fern\u0026aacute;ndez-Arroyo, L. et al (2021) Intraperitoneal pressure: Stability over time and validation of Durand's measurement method. \u003cem\u003ePeritoneal dialysis international: journal of the International Society for Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(4), 427\u0026ndash;431. https://doi.org/10.1177/0896860820973120\u003c/li\u003e\n\u003cli\u003e de Jes\u0026uacute;s Ventura, M, Amato, D, Correa-Rotter, R, et al. (2000) Relationship between fill volume, intraperitoneal pressure, body size, and subjective discomfort perception in CAPD patients. Mexican Nephrology Collaborative Study Group. \u003cem\u003ePeritoneal dialysis international: journal of the International Society for Peritoneal Dialysis\u003c/em\u003e, \u003cem\u003e20\u003c/em\u003e(2), 188\u0026ndash;193.\u003c/li\u003e\n\u003cli\u003e Kirkpatrick, A. W, Roberts, D. J, De Waele, J, et al. (2013) Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. \u003cem\u003eIntensive care medicine\u003c/em\u003e, \u003cem\u003e39\u003c/em\u003e(7), 1190\u0026ndash;1206. https://doi.org/10.1007/s00134-013-2906-z\u003c/li\u003e\n\u003cli\u003e Fischbach, M, Terzic, J, Provot, E, Weiss, L, Bergere, et al. (2003) Intraperitoneal pressure in children: fill-volume related and impacted by body mass index. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 23(4), 391\u0026ndash;394.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7495432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7495432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: The increased Intraperitoneal Pressure（IPP）is considered the predisposing factor for complications of PD in children, however the research on IPP on peritoneal dialysis patients in China remains limited, particularly in children.This study aim to further determine the relevant factors for increased IPP in children undergoing peritoneal dialysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe conducted a retrospective observational study of children under 18\u0026nbsp;years of age with peritoneal dialysis at Children’s Hospital of Fudan University between May 2019 and June 2024.Patient characteristics,IPV,IPPs were collected.IPPs were measured continuously at different filling volumes.the Univariate analysis and multivariate linear regression were used to assess the risk factor of IPP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eA total of 101 cases of children were collected,of which 53(52.5%) cases was male,median age of 6.5(4.02,11)years.at the IPV were 600ml,800ml,1000ml,1200ml and 1400ml,the mean±SD of IPP was 9.82±2.05cmH\u003csub\u003e2\u003c/sub\u003eO,8.76±2.02cmH\u003csub\u003e2\u003c/sub\u003eO,10.86±2.16cmH\u003csub\u003e2\u003c/sub\u003eO,11.95±2.32cmH\u003csub\u003e2\u003c/sub\u003eO,12.98±2.33cmH\u003csub\u003e2\u003c/sub\u003eO.The duration time of PD (B= 0.02, p=0.03),BSA (B=-1.64, p= 0.035),and BMI(B=0.53, p\u0026lt;0.001) are significant factors associated with increased IPP while body weight was significant only in the univariate analysis, this association was no significant after multivariate adjustment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eOur study demonstrate\u003cstrong\u003e \u003c/strong\u003ethe IPP was influenced by multiple factors in PD children.Notably, BMI, BSA, and PD duration were the main independent factors,these finding have significant implication in clinical practice,IPP monitoring as a simple and non-invasive measurement technique,it provides critical insights for clinicians to optimize dialysis prescriptions, thereby refining therapeutic regimens and management strategies for pediatric PD patients.\u003c/p\u003e","manuscriptTitle":"Identification of the factors associated with intraperitoneal pressure in children with peritoneal dialysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-11 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