Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Abstract

Introduction:Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life. Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated. Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay. Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers. Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

A parental perspective on child chronic kidney disease : The lived experience of caregiving in Portugal

“…In many cases renal replacement therapy is needed, through haemodialysis, peritoneal dialysis and/or renal transplantation (cf. Deuchande et al, 2016;Tong et al, 2008;Swallow et al, 2011).…”

“…According to Diseth (2011), the development and establishment of more potent immunosuppressive medication and improvement of pre-and post-transplant care have resulted in improvements in transplant survival rates worldwide and made it possible to include infants less than two years old with ESKD in the kidney transplant programme. The preliminary objective of kidney transplant is to advance from prolonging life to aiming for long-term survival and enabling a quality of life that is as close to that of the healthy population as possible (Becherucci et al, 2016;Deuchande et al, 2016;Furth, 2006). Portugal has one of the largest transplant programmes per million inhabitants in the world, and the kidney transplantation programme is said to be leading in Europe and worldwide (Nolasco et al, 2017).…”

“…The fragile condition of small children with CKD creates a surgical challenge and criteria regarding transplantation in small children are often lacking (Vitola et al, 2013). Additionally, the supply of donors is limited and the programme in Portugal requires the child's weight to be at least 12 kilos, which makes the average waiting time about five years longer than in other international centres (Deuchande et al, 2016).…”