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Chronic peritoneal dialysis in children with special needs or social disadvantage or both: contraindications are not
Nejat Aksu1, Onder Yavascan, Murat Anil
1Department of Pediatric Nephrology, Tepecik Training and Research Hospital, Izmir, Turkey.
Insights
Chronic peritoneal dialysis (CPD) is effective for children with special needs. With proper support and a skilled team, these children can achieve good outcomes on CPD.
Area of Science:
- Pediatric Nephrology
- Dialysis Therapy
- Child Health Outcomes
Background:
- Children with special needs or social disadvantage often face unique challenges in managing chronic conditions.
- Chronic peritoneal dialysis (CPD) is a vital treatment for pediatric end-stage renal disease.
- Assessing the efficacy and safety of CPD in this vulnerable population is crucial.
Purpose of the Study:
- To identify outcomes for children with special needs or social disadvantage undergoing chronic peritoneal dialysis (CPD).
- To evaluate the safety and effectiveness of CPD in a pediatric dialysis unit for this specific patient group.
Main Methods:
- Retrospective analysis of 110 children initiated on CPD between 1995 and 2008.
- Identification of 13 patients with physical, mental, or psychosocial challenges.
- Review of underlying diseases, encountered challenges, and catheter implantation methods.
Main Results:
- The frequency of peritonitis did not differ significantly between children with and without disabilities.
- Children with disabilities experienced lower rates of catheter-related infections and non-infectious complications.
- CPD was successfully managed, with 5 children transitioning to renal transplantation, hemodialysis, or experiencing mortality.
Conclusions:
- Chronic peritoneal dialysis (CPD) is a viable and effective treatment option for children with special needs or social disadvantage.
- Appropriate family support and an experienced multidisciplinary team are essential for successful CPD outcomes in this population.
Objective:
Our aim in the present study was to identify outcomes in children with special needs or social disadvantage, or both, receiving chronic peritoneal dialysis (CPD) treatment in a pediatric dialysis unit.
Methods:
Among 110 children started on CPD in our unit during the period between November 1995 and November 2008, we identified 13 patients (8 girls, 5 boys) with major physical, mental, or psychosocial problems. Age at CPD initiation in the group with disability ranged from 4.0 years to 16.5 years (median: 7.5 years). Under lying diseases were vesicoureteral reflux (4 patients), neuropathic bladder and vesicoureteral reflux (3 patients), chronic pyelonephritis (3 patients), amyloidosis (2 patients), and Alport syndrome (1 patient). Challenges encountered were adverse family or social circumstances (4 patients), cerebral palsy (3 patients), Down syndrome (1 patient), rectovesical fistula in conjunction with ectopic anus and previous multiple abdominal surgery (1 patient), blindness and deafness (1 patient), ventriculoperitoneal shunt (1 patient), colostomy and malnutrition (1 patient), and mental retardation and blindness (1 patient). All catheters were implanted percutaneously.
Results:
Median duration of dialysis was 18 months (range: 6 - 124 months). The frequency of peritonitis was not different between children with and without disability (p > 0.05). In children with disability compared with children without disability, the frequencies of catheter-related infections (1 episode/79.3 patient-months vs 1 episode/32.4 patient-months) and of catheter-related non-infectious complications (1 episode/238 patient-months vs 1 episode/115.7 patient-months) were lower (p < 0.05). Chronic peritoneal dialysis was terminated in 5 children (for renal transplantation in 3, switch to hemodialysis in 1, death in 1).
Conclusions:
Our results suggest that, with appropriate family support and an experienced multidisciplinary team, CPD can be effectively performed in children with special needs or social disadvantage, or both.
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