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Six years' experience with continuous ambulatory peritoneal dialysis and chronic hemodialysis in Saudi children
A M Mahmoud1, M H Hassab, M A El-Sibai
1Department of Pediatric Nephrology, Department of Surgery and Department of Vascular Surgery, Maternity Children's Hospital, Riyadh, Saudi Arabia.
Insights
Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) are crucial for pediatric End-Stage Renal Disease (ESRD) patients. An integrated service allows flexible treatment choices, improving outcomes for children with kidney failure.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- End-Stage Renal Disease (ESRD) significantly impacts children's health.
- Dialysis, including CAPD and HD, are vital treatment modalities for pediatric ESRD.
Purpose of the Study:
- To evaluate the outcomes of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) in children with ESRD.
- To assess the efficacy and complications of different dialysis modalities in a pediatric population.
Main Methods:
- Retrospective analysis of 80 pediatric ESRD patients treated over six years.
- Comparison of outcomes between 48 patients on CAPD and 32 patients on HD.
- Evaluation of device failures, mortality, and treatment transfers between modalities.
Main Results:
- CAPD had a higher rate of catheter failure (31.4%) compared to HD vascular access failure (42.2%).
- HD demonstrated superior three-year actuarial survival rates (94% at 1 year, 64% at 3 years) compared to CAPD (81% at 1 year, 42% at 3 years).
- Significant patient transfers occurred between CAPD and HD, highlighting the need for modality flexibility.
Conclusions:
- An integrated dialysis service offering both CAPD and HD is essential for pediatric ESRD management.
- Flexibility in switching between CAPD and HD optimizes treatment selection for individual children.
- This approach supports better management of pediatric kidney failure through adaptable dialysis strategies.
Abstract:
Eighty children with End Stage Disease (ESRD) were treated in our unit over a six year period. Forty-eight were treated with CAPD (mean age = 5.8 years) and thirty-two with HD (mean age = 8.2 years). The average duration of treatment was 14.8 months in the CAPD group and 14.2 months in the HD group. There were 22 failures of peritoneal catheter in the CAPD group out of 70 catheters compared to 19 failures of vascular access devices out of 45 in the HD group. Peritoneal catheter failure was due to resistance or recurrent peritonitis in 10 (45.4%) and obstruction in nine (41%), whereas vascular access devices failure was due to thrombosis in six (31.5%) and infection in five (26.3%). Fifteen (31.3%) of the CAPD patients died and eight (16.7%) transferred to HD, whereas five (15.6%) HD patients died and four (12.5%) transferred to CAPD. The three year actuarial rates for CAPD were 81% at one year, 55% at two years and 42% at three years, while for HD was 94%, 85% and 64%, respectively. In this unique experience at the Kingdom so far, we found that a fully integrated service of dialysis including both CAPD and HD are essential. Such a system allows the optimal mode of treatments to be chosen for a child at any time and allows the child to move freely from one treatment to another when needed.
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