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Peritoneal dialysis in children under two years of age
Hanne Laakkonen1, Tuula Hölttä, Tuula Lönnqvist
1Department of Paediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. hanne.laakkonen@hus.fi
Insights
Continuous peritoneal dialysis (CPD) in infants showed reassuring results, with low mortality, acceptable lab values, and good growth. However, hypertension remains a concern, and inguinal hernias require routine correction.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Infant Health
Background:
- Outcomes for pediatric peritoneal dialysis (PD) have improved, but the youngest patients face challenges.
- Infants on PD experience poorer growth, higher infection rates, and increased mortality compared to older children.
Purpose of the Study:
- To evaluate the efficacy and safety of continuous peritoneal dialysis (CPD) in infants under two years old.
- To assess growth, infection rates, mortality, and common complications in this young patient cohort.
Main Methods:
- Retrospective analysis of 23 children under age 2 treated with CPD between 1995-2000 in Finland.
- Review of diagnoses, anuric status, complications (hernias, hypertension), and clinical outcomes (growth, mortality, hospitalization).
Main Results:
- The mean age at PD onset was 0.4 years; mean dialysis duration was 1.4 years.
- 57% had hernias, 70% experienced hypertension. Peritonitis rate was 1:14.5 patient-months.
- Catch-up growth occurred in 64% (mean hSDS improved from -2.0 to -1.6). Mortality was 9% (2 patients).
Conclusions:
- CPD in infants is associated with low mortality, acceptable laboratory parameters, and good growth.
- Peritonitis rates are comparable to older children, but hypertension is a significant issue.
- Routine inguinal hernia correction is recommended; hypertension management requires attention.
Background:
Although results of peritoneal dialysis (PD) in small children have improved during recent years, the youngest children have poorer growth, more infections and higher mortality than do older children.
Methods:
In this retrospective study, we analysed patient records of all children under age 2 treated with continuous peritoneal dialysis (CPD) between 1995 and 2000 in Finland. Diagnoses leading to renal failure in these 23 children were congenital nephrotic syndrome of the Finnish type (13), polycystic kidney disease (4), a urethral valve (3), renal insufficiency due to neonatal asphyxia (2) and Prune-Belly syndrome (1). Of these 23, 17 (74%) were anuric.
Results:
The mean age at the onset of PD was 0.4 years and the mean time on dialysis 1.4 years. Hernias were diagnosed in 57%. The peritonitis rate was 1:14.5 patient-months, and 30% were peritonitis-free. Hypertension was common, and 70% had at least one period on antihypertensive medication. None of the patients had pulmonary oedema or dialysis-related seizures. The mean height standard deviation score (hSDS) at the start of PD (n = 16) was -2.0 and after 9 months -1.6. Catch-up growth was documented in 64% of the patients during dialysis. Hospitalization time was 124 days/patient-year. Two patients (9%) died.
Conclusions:
Our results are reassuring. Mortality was low, laboratory parameters were acceptable and growth was good. Peritonitis rate was comparable to that in older children. Correction of inguinal hernia should be routinely performed; high blood pressure is still a problem.
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