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Peritoneal dialysis in critically ill children in resource-limited setting: A prospective cohort study
Pallavi Choudhary1, Virendra Kumar1, Abhijeet Saha1
1Department of Paediatrics, 28856Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Peritoneal dialysis (PD) is a life-saving procedure for critically ill children with renal impairment. This study shows PD effectively improves kidney function, even in those with shock or on mechanical ventilation.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is an accessible life-saving procedure for pediatric renal impairment.
- Limited data exists on PD efficacy in critically ill children, particularly those in shock or on mechanical ventilation.
Purpose of the Study:
- To evaluate the efficacy and outcomes of PD in critically ill children.
- To assess PD's effectiveness in pediatric patients with acute kidney injury (AKI) and chronic kidney disease (CKD).
Main Methods:
- A prospective observational study was conducted on 50 critically ill children (1 month to 14 years) in a pediatric intensive care unit.
- PD efficacy and patient outcomes were monitored.
- Data included indications for PD, patient condition (shock, mechanical ventilation), biochemical parameters, complications, and mortality.
Main Results:
- Acute kidney injury (AKI) was the primary indication for PD (66%), often caused by sepsis, malaria, or dengue.
- At PD initiation, 26% of patients were in shock and 46% required mechanical ventilation.
- PD demonstrated effectiveness within hours, improving pH, bicarbonate, and lactate levels, with sustained improvement in estimated glomerular filtration rate (eGFR). Complications occurred in 14%, with 4% peritonitis. Mortality was 14%, associated with shock and mechanical ventilation.
Conclusions:
- Acute peritoneal dialysis is a life-saving intervention for critically ill children with renal impairment.
- Combined treatment of shock, respiratory failure (mechanical ventilation), and PD leads to favorable renal outcomes.
Background:
Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation.
Methods:
In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India.
Results:
Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95-26.69; p < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01-83.10; p < 0.02) were associated with mortality.
Conclusions:
Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.
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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...