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A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young
Agathe B Nkoy1, Yoli M Ndiyo1, Therance T Matoka1
1Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo.
Insights
A new pediatric peritoneal dialysis (PD) program in the Democratic Republic of Congo (DRC) successfully treated children with acute kidney injury (AKI). This initiative demonstrated effective life-saving interventions with locally produced PD fluids and low complication rates.
Area of Science:
- Pediatric Nephrology
- Public Health
- Renal Medicine
Background:
- Acute kidney injury (AKI) is a significant contributor to child mortality in the Democratic Republic of Congo (DRC).
- Limited resources, including a shortage of pediatric nephrology specialists and a lack of pediatric dialysis programs, exacerbate this challenge.
- Poverty and infectious diseases like severe malaria and sepsis are major underlying causes of AKI in children in the DRC.
Purpose of the Study:
- To describe the initial experience and outcomes of the first pediatric acute peritoneal dialysis (PD) program established in the DRC.
- To evaluate the feasibility and effectiveness of PD in managing pediatric AKI in a resource-limited setting.
- To assess the epidemiology, clinical features, and treatment outcomes of children with AKI managed by PD.
Main Methods:
- A retrospective cohort study was conducted at the University Hospital of Kinshasa from January 2018 to January 2019.
- The study included children aged 4 months to 15 years admitted with AKI.
- Treatment involved acute peritoneal dialysis (PD), with PD fluids produced locally, and bedside catheter insertion techniques.
- Training for the medical team was supported by international collaborations.
Main Results:
- Out of 49 children admitted with AKI, 35 required dialysis, with 32 treated using PD.
- The primary indications for dialysis were uremia and prolonged anuria.
- 75% of the children treated with PD recovered normal renal function within 3 months post-discharge.
- A low rate of peritonitis (6.2%) was observed, and the overall mortality rate was 18.7%.
Conclusions:
- The establishment of a pediatric PD program in the DRC is a promising and effective strategy for managing acute kidney injury in children.
- Simple means, including locally produced PD fluids and skilled nursing care, can lead to successful outcomes.
- This initiative demonstrates the potential to significantly reduce child mortality associated with AKI in resource-limited settings.
Abstract:
In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.
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