Peritoneal Dialysis in Children with Acute Kidney Injury: Dhaka Shishu (Children) Hospital Experience

Abstract

ORIGINAL ARTICLEand dialyzers, combined with the cost of treatment, challenges in obtaining vascular access, and a need for specialized staff. Intermittent HD is also technology-dependent, and in our country, age-and size-appropriate blood lines, dialyzers, and catheters for infants and young children are also scarce. Furthermore, young children may not tolerate the volume shifts that occur during HD 7. The most readily available modality of RRT for young children with AKI in resource-limited countries is PD 8,9. The mortality rate in children with AKI is highly variable and considered to depend largely on the nature of the underlying disease process and early initiation of PD rather than on renal failure itself. Children with AKI caused by a renal-limited condition such as post-infectious glomerulonephritis reportedly have a very low mortality rate (<1%), IntroductionAcute kidney injury (AKI) is a common problem associated with increased mortality and health care costs. Renal replacement therapy (RRT) is the main option for management of AKI patients. Continuous RRT and intermittent hemodialysis (HD) are the modalities most commonly used in developed countries 1,2 . In the developing countries PD is frequently used because of its lower cost and minimal infrastructure requirements 3,4 . Recently, interest in using PD to manage patients with AKI has been increasing. It has been postulated that PD may be more physiologic and less inflammatory than HD in AKI because of the absence of contact between blood and synthetic membranes 5, On the other hand, the technique for PD is relatively simple 6 . In the developing countries or resource-poor settings, continuous RRT is limited because of a lack of ageappropriate vascular catheters, pediatric blood lines, Peritoneal Dialysis in Children with Acute Kidney Injury: Dhaka Shishu (Children) Hospital Experience. The choices for renal replacement therapy (RRT) in children with acute kidney injury (AKI) are limited in developing countries. Peritoneal dialysis (PD) is the preferred and convenient treatment modality for acute kidney injury (AKI) in children and hemodynamically unstable patients. Methods: This is a cross sectional descriptic type of observational study of children who underwent PD for AKI in 43 children (27 boys) in nephrology department of Dhaka Shishu (children) Hospital from January 2013 to December 2013. Result: The study included 43 children (62.8 % male). Mean age was 2 ± 1.07 years, with the youngest being 2 months, and the oldest, 14 years. Most common causes was septicaemia (25.6%) and hypovolumia (25.6%) followed by unknown etiology (16.2%), glomerulonephritis (11.6%), wasp sting (9.3%) and hemolytic uremic syndrome (7%). Overall mortality was 32.5%, most common in unknown etiology and high in male but not statistically significant (p=0.42). Conclusions: In the developing countries, PD can be successfully performed for the management of childhood AKI. Septicaemia and hypovolumia are the leading causes of AKI, however mortality higher in male and unknow...

Long-term survival of children following acute peritoneal dialysis in a resource-limited setting

“…Although there is a paucity of comparable studies, two studies in India examined factors associated with mortality in children who underwent PD for AKI. They found no relationships with age [ 13 , 34 ]. However, a review of the long-term outcomes of chronic dialysis in children detected higher mortality in the younger age group [ 35 ].…”