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Continuous ambulatory peritoneal dialysis for children with end stage renal disease
1Department of Pediatrics, Veterans General Hospital, Taipei, Taiwan, R.O.C.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) effectively treats pediatric end-stage renal disease (ESRD), improving patient well-being and physical development. While peritonitis is a risk, CAPD offers a viable long-term therapy option for children with ESRD.
Area of Science:
- Pediatrics
- Nephrology
- Internal Medicine
Background:
- End-stage renal disease (ESRD) presents significant challenges for pediatric patients.
- Continuous ambulatory peritoneal dialysis (CAPD) is an alternative treatment modality for ESRD.
Purpose of the Study:
- To evaluate the efficacy and outcomes of CAPD in children with ESRD.
- To assess biochemical, clinical, and developmental changes in pediatric ESRD patients undergoing CAPD.
Main Methods:
- A cohort of ten children (ages 4-16) with ESRD were treated with CAPD from 1986-1989.
- Patients received hospital-based training for CAPD procedures.
- Biochemical parameters, clinical status, complications, and physical development were monitored.
Main Results:
- Significant improvements were observed in BUN, creatinine, potassium, phosphorus, alkaline phosphatase, sodium, and calcium levels.
- Anemia improved, hypertension was controlled, and serum protein/albumin increased, despite protein loss.
- Hypercholesterolemia and hypertriglyceridemia were noted; peritonitis occurred in 30% of patients (1 episode/17.2 patient-months).
- Seven patients remained on CAPD, three received transplants, and most reported improved well-being and physical growth.
Conclusions:
- CAPD is a safe and effective long-term treatment for pediatric ESRD.
- It leads to significant biochemical improvements and enhanced quality of life for children.
- CAPD facilitates easier management and supports physical development in pediatric ESRD patients.
Abstract:
From June 1986 to October 1989, ten children suffering from end stage renal disease (ESRD) were treated with continuous ambulatory peritoneal dialysis (CAPD). Their ages ranged from 4 to 16 years; 3 were boys and 7 were girls. IgM mesangial nephropathy (IgMN) (three cases) were the most common causes of renal failure in the patients. All patients were trained in the hospital. After CAPD treatment, serum BUN and creatinine dropped significantly. Serum levels of potassium, phosphorus, and alkaline phosphatase dropped and serum sodium and calcium rose significantly after treatment. Improvement of anemic state and control of hypertension were also noted. Hypercholesterolemia and hypertriglyceridemia developed after CAPD treatment. Despite protein loss through the peritoneal cavity, there was no evidence of protein malnutrition. Total serum protein and albumin increased significantly after treatment. The most common complication was peritonitis. Three of these 10 patients developed an episode of peritonitis, or an incidence of 1 episode per 17.2 patient months. To the present, seven patients are still doing well on CAPD. Three patients have received renal transplantation. The majority of the patients experienced an increased sense of well-being, easier diet and fluid management, freedom for travel and daily activities. Physical development also improved, with body length and body weight gaining steadily. It can be concluded that CAPD is a good modality of long-term therapy for ESRD children.