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Efficacy of CAPD as the primary treatment for end-stage renal failure in children
M Barakat1, J M Savage, A Burns
1Department of Child Health, Queen's University of Belfast, UK.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) is a viable first option for childhood end-stage renal failure (ESRF) when hemodialysis is unavailable. This study found no deaths and manageable complications in children treated with CAPD.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- End-stage renal failure (ESRF) in children presents unique challenges.
- Continuous ambulatory peritoneal dialysis (CAPD) has been the primary treatment modality for pediatric ESRF in Northern Ireland for six years.
- Evaluating the efficacy and safety of CAPD in this pediatric population is crucial.
Purpose of the Study:
- To assess the outcomes of children with ESRF treated with CAPD.
- To identify complications associated with CAPD in pediatric patients.
- To determine the suitability of home CAPD as a first-line treatment for childhood ESRF.
Main Methods:
- Retrospective analysis of 22 children with ESRF treated with CAPD over a six-year period.
- Data collection on treatment outcomes, complications, and patient demographics.
- Comparison with renal transplant data where applicable.
Main Results:
- No deaths occurred among the 22 CAPD-treated patients.
- The incidence of peritonitis was one episode per 11.6 patient treatment months.
- Complications included peritonitis (requiring catheter replacement in 3 patients), exit site infections, hernia, and hydrothorax.
- Peritonitis, undernutrition, growth retardation, and developmental delay were more prevalent in children under two years of age.
Conclusions:
- Home CAPD is a recommended and viable first-line treatment for pediatric ESRF, especially when hemodialysis facilities are not readily accessible.
- Careful monitoring is essential to manage complications, particularly in younger children.
- CAPD offers a life-sustaining treatment option with no mortality in this cohort.
Abstract:
In the 6 years before this paper, all children presenting with end-stage renal failure (ESRF) in Northern Ireland were electively commenced on continuous ambulatory peritoneal dialysis (CAPD). In that period, 22 patients were treated, 16 received renal transplants and 6 remained on CAPD. Active treatment was withdrawn in 1 child due to obliterative peritonitis. There were no deaths. One incident of peritonitis was documented per 11.6 patient treatment months. Recurring peritonitis lead to catheter replacement in 3 patients. Other problems encountered were catheter exit site infections, hernia formation and in one instance, hydrothorax. Peritonitis was more common in children under 2 years of age as was undernutrition, growth retardation and developmental delay. Home CAPD can be recommended as a viable first option treatment for childhood ESRF where suitable haemodialysis facilities are not easily accessible.