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Outcome and risk factors for mortality in pediatric peritoneal dialysis
Hsin-Lin Tsai1, Ling-Yu Yang, Tai-Wai Chin
1Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, School of Medicine, Taipei, Taiwan.
Insights
Mortality was low for children on continuous ambulatory peritoneal dialysis (CAPD). Low serum albumin independently predicted death in pediatric CAPD patients, highlighting its importance in managing these young individuals.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- End-Stage Renal Disease (ESRD) Management
Background:
- Children with ESRD requiring renal replacement therapy face higher mortality rates.
- Limited data exists on mortality risk factors in pediatric patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Adult CAPD patients show associations between hypoalbuminemia, high peritoneal transport, and lower survival.
Purpose of the Study:
- To analyze clinical characteristics of pediatric CAPD patients.
- To identify routinely used laboratory and clinical variables as independent risk factors for mortality in children on CAPD.
Main Methods:
- Retrospective chart analysis of pediatric ESRD patients on CAPD (January 1997 - September 2008).
- Enrolled 29 patients on CAPD for over 3 months.
- Analyzed clinical and biochemical variables in survivors versus nonsurvivors.
Main Results:
- Actuarial survival rates at 2 and 5 years were 96.55% and 91.19%, respectively.
- Peritonitis was the major complication (1 episode/57.79 patient-months).
- Univariate analysis identified younger age, comorbid disease, high peritoneal transport, protein loss, hypoalbuminemia, and hypophosphatemia as associated with mortality. Multivariate analysis revealed only low serum albumin as an independent predictor (HR 8.06, p=0.006).
Conclusions:
- Pediatric CAPD patients demonstrated low mortality rates.
- Hypoalbuminemia was significantly associated with increased mortality risk in this pediatric CAPD cohort.
Background:
The mortality rate among children requiring renal replacement therapy is higher than in children without end-stage renal disease (ESRD). Some factors, such as hypoalbuminemia, high peritoneal transport rate, age, malnutrition, cardiovascular disease, and recurrent peritonitis, appear to be associated with lower survival in adult peritoneal dialysis patients. Data regarding risk factors of mortality in children with continuous ambulatory peritoneal dialysis (CAPD) are limited. The aims of this study were to analyze the clinical characteristics of patients and investigate if routinely used laboratory and clinical variables are independent risk factors for mortality in children on CAPD.
Methods:
We performed a retrospective chart analysis of pediatric ESRD patients on CAPD between January 1997 and September 2008. 29 patients undergoing CAPD for more than 3 months were enrolled. An analysis was performed on clinical and biochemical variables for survivors and nonsurvivors to identify potential risk factors for mortality.
Results:
Mean age was 12.18 +/- 4.57 years. During the follow-up period, 8 patients transferred to hemodialysis and 13 patients received deceased donor renal transplantation. By the end of the study, 5 patients had died. Actuarial survival rate at 2 and 5 years was 96.55% and 91.19% respectively. The major complication during therapy was peritonitis (1 episode/57.79 patient-months). In the univariate analysis, younger age at initiation of dialysis, presence of comorbid disease, higher peritoneal transport rate, increased protein losses through peritoneal dialysis, high total daily protein loss, hypoalbuminemia, and hypophosphatemia were variables associated with mortality in pediatric CAPD patients. However, in the multivariate analysis, only low serum albumin (b = -2.089, p = 0.006; hazard ratio 8.06, 95% confidence interval 0.028 - 0.546) was independently associated with mortality.
Conclusion:
Mortality was low in our pediatric patients receiving CAPD. Hypoalbuminemia showed a significant association with death in CAPD patients.
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