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Long-term outcome of peritoneal dialysis in infants
S E Ledermann1, M E Scanes, O N Fernando
1Departments of Nephrology and Urology, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom.
Insights
Peritoneal dialysis in infants with end-stage renal disease offers positive outcomes for growth and development, justifying its intensive approach despite challenges like co-morbidity and catheter interventions. Long-term success is achievable with careful management.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Infant Health
Background:
- Infantile end-stage renal disease (ESRD) presents complex treatment challenges.
- Peritoneal dialysis (PD) is a viable, though intensive, treatment option for infants with ESRD.
- Long-term outcomes and growth patterns in infants undergoing PD require further evaluation.
Purpose of the Study:
- To evaluate the progress and outcomes of infants with ESRD treated with long-term peritoneal dialysis.
- To assess growth parameters, developmental milestones, and transplantation success rates in this cohort.
- To identify factors influencing outcomes, including co-morbidities and treatment complications.
Main Methods:
- A retrospective analysis of 20 infants undergoing long-term peritoneal dialysis at a single center.
- Data collection included patient demographics, dialysis duration, co-morbidities, interventions, and clinical outcomes.
- Growth parameters (weight, height, head circumference) and developmental milestones were tracked over time.
Main Results:
- Eleven infants received renal transplants; 4 required hemodialysis before transplantation.
- Significant co-morbidities were noted in infants with poor outcomes (death or hemodialysis).
- Improved weight, height, and head circumference standard deviation scores were observed during PD; 14/16 survivors achieved normal development.
Conclusions:
- Peritoneal dialysis in infancy is a demanding but effective treatment for ESRD, supporting favorable growth and development.
- Renal transplantation is a successful outcome for a majority of infants treated with PD.
- Emphasizing non-renal co-morbidities during parental counseling is crucial for managing expectations and care.
Abstract:
Debate continues concerning the treatment of infants with end-stage renal disease. We evaluated progress and outcome of 20 infants with a mean age of 0.34 year (range, 0.02-1 year) in a long-term peritoneal dialysis program at a single center. Mean weight at the start of dialysis was 4.8 kg (range, 1.7-11.4 kg), and the duration of dialysis was 17.3 months (range, 1-59 months). Eleven infants received renal transplants, 4 were switched to hemodialysis and then received transplants, 4 died, and 1 continues to receive peritoneal dialysis. There was significant co-morbidity in 6 infants who died or required hemodialysis. Catheter interventions were frequent, with 12 infants requiring at least one replacement. There were 1.1 episodes of peritonitis per patient-year; 70% of infants had 0 to 1 episode. Mean weight standard deviation score (SDS) was -1.6 at the start, -0.3 at 1 year (P =.0008), and 0.3 at 2 years (P =.0008). Height SDSs were -1.8 at the start, -1.1 at 1 year (P =.046), and -0. 8 at 2 years (P =.06). Head circumference SDSs were -1.9 at the start, -1.3 at 6 months (P =.003), and -0.9 at 1 year (P =.015). Fourteen of 16 survivors are achieving normal developmental milestones or attend mainstream school. Peritoneal dialysis in infancy is a demanding treatment, but outcome for growth, development, and transplantation justifies this intensive approach. When parents are counseled, the importance of non-renal co-morbidity must be emphasized.