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Pediatric peritoneal dialysis in Korea: practical solutions to the problems of peritoneal dialysis for children
Insights
This study analyzed pediatric peritoneal dialysis (PD) in Korea, finding peritonitis to be the most common complication in both continuous ambulatory PD and acute PD. Early diagnosis of reflux nephropathy is crucial for preventing end-stage renal disease.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Complications
Background:
- Peritoneal dialysis (PD) is a vital treatment for pediatric end-stage renal disease (ESRD).
- Understanding common challenges in pediatric PD is essential for optimizing patient outcomes.
- Data from Korean pediatric PD cases can offer unique insights into regional trends and complications.
Purpose of the Study:
- To identify and address prevalent issues encountered in pediatric peritoneal dialysis (PD) in Korea.
- To analyze clinical data from continuous ambulatory PD (CAPD) and acute PD in children.
- To provide evidence-based recommendations for improving pediatric PD care.
Main Methods:
- Retrospective analysis of 264 pediatric PD cases (CAPD and acute PD) from 18 Korean institutions (1987-1997).
- Data collection included patient demographics, causes of ESRD, PD duration, and complication types and incidence.
- Microbiological data for peritonitis cases were also analyzed.
Main Results:
- Peritonitis was the most frequent complication in both CAPD (0.96 episode/patient-year) and acute PD (78.3%).
- Common causes of ESRD included focal segmental glomerulosclerosis and reflux nephropathy; congenital anomalies were less frequent.
- Staphylococcus aureus and coagulase-negative staphylococcus were primary pathogens for peritonitis in both PD types.
Conclusions:
- Early detection and management of reflux nephropathy are critical for preventing pediatric ESRD.
- Continuous ambulatory PD did not significantly improve growth status in the studied pediatric population.
- Peritonitis incidence escalated notably within two weeks of initiating acute PD.
Purpose:
To find and solve the common problems of peritoneal dialysis (PD) by analyzing the clinical data of pediatric PD performed in Korea.
Methods:
We looked at 264 cases of continuous ambulatory peritoneal dialysis (CAPD) and acute PD that were performed in 18 institutions of pediatric nephrology in Korea from November 1987 to October 1997.
Results:
CAPD was performed in 114 cases. The mean age of the patients was 10.5+/-6.6 years, and the male-to-female ratio was 1.4:1. The original causes of end-stage renal disease (ESRD) were proven in 92 cases (81%). The most common renal diseases were focal segmental glomerulosclerosis (17%), reflux nephropathy (11%), and chronic glomerulonephritis (11%). Mean duration of CAPD was 20 months+/-16.9 months. Peritonitis was the most common complication, and the peritonitis incidence was 0.96 episode per patient-year. Other complications were exit-site infection in 10 cases, obstruction in 7 cases, and leakage of dialysate in 6 cases. The most common etiologic organism of peritonitis was Staphylococcus aureus and the next most common was coagulase-negative staphylococcus. Acute PD was performed in 150 cases. The most common underlying causes were congenital heart disease, hemolytic uremic syndrome, sepsis, and dehydration. The mean duration was 10.3+/-11.3 days. The most common complication was peritonitis (78.3%). The most common etiologic organisms of peritonitis were Staphylococcus aureus, coag-neg staphylococcus, Acinetobacter, and Pseudomonas.
Conclusion:
Reflux nephropathy should be emphasized in early diagnosis and treatment to prevent ESRD. Incidence of congenital anomaly (7%) as a original cause of ESRD was relatively low in Korea. Growth status was not significantly improved after CAPD. In acute PD, the incidence of peritonitis rapidly increased at 2 weeks after the start of dialysis.