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Peritoneal dialysis in children with acute kidney injury: a developing country experience
Om P Mishra1, Aditya K Gupta, Vishal Pooniya
1Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. opmpedia@yahoo.co.uk
Insights
Acute peritoneal dialysis (PD) is a feasible treatment for pediatric acute kidney injury (AKI). However, high mortality rates are linked to septicemia and severe AKI, especially in resource-poor settings.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Critical Care Medicine
Background:
- Peritoneal dialysis (PD) is a convenient and preferred treatment for acute kidney injury (AKI) in children and hemodynamically unstable patients.
- Its role in resource-limited settings warrants further investigation.
Purpose of the Study:
- To evaluate the outcomes of acute PD in pediatric patients with AKI.
- To identify risk factors associated with mortality in this population.
Main Methods:
- A study was conducted on 57 children (aged 1 month to 12 years) with AKI who underwent acute PD.
- Data collected included causes of AKI, PD effectiveness, and mortality rates.
- Multivariate analysis was used to determine risk factors for mortality.
Main Results:
- Hemolytic uremic syndrome was the most common cause of AKI (36.8%), followed by septicemia (24.6%) and acute tubular necrosis (19.3%).
- PD effectively lowered retention markers (p < 0.001).
- Overall mortality was 36.8%. Anuria (OR: 8.2), septicemia (OR: 3.79), and severe infectious complications (OR: 8.2) were significant risk factors for mortality.
Conclusions:
- Acute PD is a viable treatment option for pediatric AKI in resource-poor settings due to its simplicity and feasibility.
- Septicemia and the severity of AKI are key contributors to high mortality rates in pediatric AKI patients.
Background:
Peritoneal dialysis (PD) is the preferred and convenient treatment modality for acute kidney injury (AKI) in children and hemodynamically unstable patients.
Methods:
The outcome of acute PD was studied in 57 children (39 boys) with AKI, aged 1 month to 12 years, at a tertiary care center of a teaching hospital in India.
Results:
Hemolytic uremic syndrome (36.8%) was the most common cause of AKI, followed by septicemia (24.6%) and acute tubular necrosis (19.3%). Treatment with PD was highly effective in lowering retention markers (p < 0.001). Overall mortality was 36.8%. The risk of mortality by multi-variate analysis was higher when patients were anuric [odds ratio (OR): 8.2; 95% confidence interval (CI): 1.3 to 49; p < 0.05], had septicemia (OR: 3.79; 95% CI: 1.55 to 25.8; p < 0.05), or severe infectious complications (OR: 8.2; 95% CI: 1.5 to 42.9; p < 001).
Conclusions:
Because of its simplicity and feasibility, acute PD is still an appropriate treatment choice for children with AKI in resource-poor settings. Septicemia and severity of AKI are contributory factors to high mortality in pediatric acute kidney injury.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...