Peritoneal Dialysis in Children with Acute Kidney Injury: A Developing Country Experience

Abstract

Because of its simplicity and feasibility, acute PD is still an appropriate treatment choice for children with AKI in resource-poor settings. Septicemia and severity of AKI are contributory factors to high mortality in pediatric acute kidney injury.

Peritoneal Dialysis for Children with Acute Kidney Injury in Lagos, Nigeria: Experience with Adaptations

“…This view is supported by the observation that over half of the children who died received PD for two or fewer days, with two children dying after only one dwell of PD fluid. Nonetheless, the mortality rate in the present study is mid-way in the range of mortality rates described in various studies of AKI from other developing regions of the world (7,12,15). In a recent study from Ibadan, southwest Nigeria which documented a 70% survival rate in children who received PD for AKI, nine children who died from AKI following diethylene glycol poisoning and another five children whose hospital records were not available were excluded from analysis (7).…”

“…In the two children who developed peritonitis, PD was performed for longer periods (12 and 18 days, respectively) and both had leakages from the PD site and exit site infection. Similarly low peritonitis rates have been reported in developing countries supporting the safety of PD for AKI in resource-poor settings (11,12). A common complication, however, was catheter blockage leading to a ball-valve effect in which filling was easily achieved but drainage of peritoneal cavity was ineffective.…”

Acute Kidney Injury in Children withPlasmodium FalciparumMalaria: Determinants for Mortality

“…Although PD is less effective because of the complicating circulatory disturbances, it is often the only dialytic modality available in areas where malaria is endemic. Because of its simplicity and feasibility in developing countries, it can be instituted earlier wherever indicated (23). Attention should be given to comorbidities regarding management as their presence adversely affects the outcome.…”

Peritoneal Dialysis for Acute Kidney Injury

“…Whereas many commercially prepared solutions for acute PD are lactate based with a concentration of 35 -40 mmol/L, more biocompatible solutions (e.g. bicarbonate-or lactate/ bicarbonate-based) are available in countries other than the United States and have been used for acute PD (91)(92)(93). On occasion, infants and young children do not tolerate the lactate absorbed from the dialysis solution in the setting of hepatic dysfunction, hemodynamic instability, and persistent/worsening metabolic acidosis.…”