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Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study
Narayan Prasad1, Dharshan Rangaswamy2, Manas Patel3
1Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India. narayan.nephro@gmail.com.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) offers a viable treatment for pediatric end-stage renal disease, demonstrating significant patient and technique survival rates. This study highlights CAPD
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Peritoneal dialysis (PD) is a preferred dialysis method for children with end-stage renal disease (ESRD).
- Understanding technique failure and survival rates in pediatric PD is crucial for effective management.
Purpose of the Study:
- To evaluate the incidence of technique failure and patient survival in children undergoing continuous ambulatory peritoneal dialysis (CAPD).
- To analyze the long-term outcomes of CAPD in pediatric ESRD patients.
Main Methods:
- A cohort of children under 18 years initiating PD between 2005 and 2016 was studied.
- Kaplan-Meier survival analysis was used to assess CAPD outcomes, including patient and technique survival.
- Data on peritonitis episodes and catheter types were collected.
Main Results:
- 66 children received 68 Tenckhoff catheters; 47% experienced peritonitis episodes (0.42 episodes/year).
- Mean patient survival was 41 months (72% at 12 months, 30% at 36 months).
- Mean technique survival was 55 months (69% at 12 months, 44% at 36 months).
Conclusions:
- CAPD is a feasible treatment option for pediatric end-stage renal disease.
- It is particularly relevant for children in developing countries lacking access to advanced dialysis modalities.
- The study provides valuable insights into CAPD efficacy and challenges in pediatric populations.
Background:
Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease.
Methods:
To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes.
Results:
A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months).
Conclusion:
CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.
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