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Continuous peritoneal dialysis in children: a single-centre experience in a developing country
Narayan Prasad1, Sanjeev Gulati, Amit Gupta
1Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Insights
Continuous peritoneal dialysis (CPD) is a viable treatment for children with end-stage renal failure (ESRF) in developing nations. This study shows CPD effectively bridges patients to kidney transplantation, offering a crucial therapeutic option.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Continuous peritoneal dialysis (CPD) is the primary dialysis method for pediatric end-stage renal failure (ESRF).
- Limited data exists on CPD in children from developing countries.
Purpose of the Study:
- To evaluate the efficacy and outcomes of continuous ambulatory peritoneal dialysis (CAPD) in children with ESRF in India.
- To assess CAPD as a bridge to renal transplantation.
Main Methods:
- Retrospective study of 30 pediatric ESRF patients (mean age 13 years) on CAPD from 1994-2004.
- Analysis of peritonitis episodes, causative organisms, and patient outcomes including transplantation, mortality, and technique failure.
Main Results:
- The peritonitis rate was 0.58 episodes per patient-year, with E. coli being the most common pathogen.
- 23.3% of patients received a renal transplant, 36.6% were awaiting transplant, 26.6% died, and 6.7% experienced technique failure.
- The mean cumulative survival time for patients on CPD was 42 months.
Conclusions:
- Continuous peritoneal dialysis is a feasible and effective dialysis modality for children with ESRF in developing countries.
- CAPD serves as a successful bridge to renal transplantation, improving patient survival and quality of life.
Abstract:
Continuous peritoneal dialysis (CPD) is the most commonly used modality of dialysis in children. Continuous ambulatory peritoneal dialysis (CAPD) has been an established form of therapy in adult patients with end-stage renal failure in India for more than a decade. There is a paucity of published experience of CPD in children from developing countries. We retrospectively studied children with end-stage renal failure (ESRD) that had been on CAPD over the past 10 years. Thirty patients with ESRD, mean age 13+/-8 years (range 5-21 years), male 18, were started on CAPD from 1994 to October 2004. The mean break-in period was 12+/-3 days. Of these 30 patients, 15 had a total of 21 episodes of peritonitis. The peritonitis rate was 0.58 episodes per patient year. E. coli was the commonest organism causing peritonitis. On outcome analysis, 7/30 (23.3%) patients received a renal transplant, while 11/30 (36.6%) continued on CAPD, awaiting a kidney transplant. Of the rest, eight (26.6%) patients died, two (6.7%) suffered technique failure and were changed to haemodialysis, and two (6.7%) were lost to follow-up after 2 months. The mean cumulative survival time of patient on CPD was 42 months. We conclude that CPD is a viable option for dialysis in ESRD children in a developing country and is a successful bridge between ESRD and renal transplantation.
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