The Japanese National Registry Data on Pediatric Capd Patients: A Ten-Year Experience a Report of the Study Group of Pediatric Pd Conference

Abstract

Objective Over the past 10 years, we have collected data on pediatric patients less than 16 years of age from the National Registry of CAPD (continuous ambulatory peritoneal dialysis). We present our experience with this population. Design The database details the patient number, age, weight, height, outcome, cause of death, reason for terminating CAPD therapy, peritonitis, and catheter survival. Patients Of the 434 patients (239 males, 195 females), 37 patients (8.5%) were under 1 year of age and 164 patients (37.8%) were under 6 years of age. About half of the patients were less than 20 kg in weight, clearly indicating that CAPD was the treatment of choice in young children. The duration on CAPD for these patients was less than 2 years for 233 patients (54%), and was 5 years or more in 48 patients (11%). Results The outcome of the total patient population of 434 as of M ay, 1991, is as follows 229 patients (52.8%) were being successfully treated with CAPD, 47 patients (10.8%) died, and 78 patients (18.0%) received a kidney transplantation. The patient survival rate was 85.6% at 3 years and 81.7% at 5 years. The technique survival rate was 74.9% at 3 years and 63.5% at 5 years. The rate of peritonitis was one episode over 28.6 patient-months. The mean catheter duration was 1.68 years. Peritonitis rate, catheter survival rate, and the rate of tunnel infection were worse in children less than 6 years of age than in older children. Conclusion The excellent patient and technique survival rates indicate that CAPD is an effective treatment for children with end-stage renal disease in Japan. The high infection rates in younger children indicate that extra careful management is needed for this young age group.

Dialysis-associated peritonitis in children

“…Similar to previous reports, the current NAPRTCS report reveals an inverse relationship between the age of the patient and peritonitis rate, with the youngest patients (<1 year) having an annualized rate of 0.86 (one infection every 13.9 months), while the adolescents (>12 years) have a rate of 0.61 (one infection every 19.8 months). These rates were derived from clinical experience in the USA and are comparable to what has been documented in European centers, but poorer than the exceptionally low rates (one infection every 28.6 months) found among Japanese children [ 23 – 25 ].…”

Mass screening for early detection of congenital kidney and urinary tract abnormalities in infancy

“…However, the present screening program for proteinuria and hematuria make it difficult to detect congenital kidney and urinary tract abnormalities at an early stage. Congenital kidney and urinary tract abnormalities account for 30% of the pediatric primary renal diseases that cause end‐stage renal insufficiency in Japan 2 . The North American Pediatric Renal Transplant Cooperative Study reported that nearly two‐thirds of children and adolescents with chronic renal insufficiency had structural anomalies of the kidneys and urinary tract 3 .…”

6. Type of peritoneal dialysis catheter

“…Honda et al . from the Japanese Registry in Pediatric CAPD patients documented better catheter survival with the double‐cuff vs. single‐cuff catheter (82.2% vs. 69.0% at 1 years and 54.2% vs. 43.2% at 2 years) but did not comment on the difference in peritonitis between the two groups in a retrospective review of 434 paediatric PD patients 11 …”

“…International Society for Peritoneal Dialysis 1998: Convincing data exist to indicate that the double‐cuff catheter is preferable to the single‐cuff catheter, therefore a double‐cuff configuration is recommended (the data they quote is retrospective data for both peritonitis 9–11 and for catheter survival time 19,20 ). A downward‐directed exit may decrease the risk of catheter‐related peritonitis.…”