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Comparison of chronic peritoneal dialysis outcomes in children with and without spina bifida
Jose Grünberg1, María Cristina Verocay, Anabella Rébori
1Hospital Evangélico, Servicio de Nefrología de Niños y Adolescentes (SENNIAD), Instituto de Medicina Altamente Especializada, Rambla Gandhi 221 ap 201, 11300 Montevideo, Uruguay. josegrunberg@movinet.com.uy
Insights
Spina bifida (SB) does not negatively impact long-term outcomes for children undergoing chronic peritoneal dialysis (CPD). This study found comparable patient survival, technique survival, and peritonitis rates between SB patients and controls, confirming CPD as a viable renal replacement therapy.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Surgical Outcomes
Background:
- Chronic peritoneal dialysis (CPD) is a crucial renal replacement therapy for children.
- The impact of congenital conditions like spina bifida (SB) on CPD outcomes requires further investigation.
- Matching for socioeconomic status (SES) and gender is essential for unbiased outcome comparison.
Purpose of the Study:
- To compare long-term CPD outcomes between pediatric patients with and without lumbar spina bifida (SB).
- To assess patient survival, technique survival, peritonitis incidence, and mortality rates in SB patients undergoing CPD.
- To determine if SB is a risk factor influencing CPD efficacy in children.
Main Methods:
- A retrospective study comparing seven pediatric SB patients with 20 matched controls undergoing CPD.
- Outcomes analyzed included patient survival, technique survival, peritonitis incidence, and death rates.
- Matching criteria included gender and socioeconomic status (SES) using the modified Graffar's method.
Main Results:
- No significant differences were observed in CPD outcomes between SB patients and controls.
- Peritonitis incidence was comparable (1 episode per 17.6 months in SB vs. 10.3 months in controls, p=0.5).
- Five-year patient survival (86% vs. 73%, p=0.55) and technique survival (83% vs. 73%, p=0.84) were similar. Average death rates were also comparable.
Conclusions:
- Spina bifida (SB) is not identified as a risk factor for chronic peritoneal dialysis (CPD) in pediatric patients.
- CPD demonstrates effectiveness and safety as a renal replacement alternative for children with SB.
- Further research can support the integration of CPD in managing pediatric renal failure associated with SB.
Abstract:
This study was designed to compare chronic peritoneal dialysis (CPD) long-term outcomes (patient and technique survival, incidence of peritonitis, and overall average death outcomes) between seven patients with lumbar spina bifida (SB) and 20 controls without SB. Both groups were matched for potentially outcome-confounding factors: gender, and socioeconomic status (SES). SES was established using modified Graffar's method. No significant differences were found in CPD outcomes. The incidence of peritonitis was one episode per 17.6 and 10.3 months in SB patients and controls, respectively (p = 0.5). Overall patient survival at 5 years was 86% and 73% in SB patients and controls, respectively (p = 0.55). Overall average death rate between SB and control patients was 47.6/1,000 and 79.4/1,000 patient years, respectively (p = 0.63). Overall technique survival at 5 years was 83% and 73% in SB patients and controls, respectively (p = 0.84). There were no cases of retrograde brain ventricular infection secondary to PD-related peritonitis. We conclude that SB is not a risk factor for CPD, and therefore, it is an effective renal replacement alternative in children with SB.
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