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Comparison of continuous ambulatory peritoneal dialysis and hemodialysis in children
Insights
Continuous ambulatory peritoneal dialysis (CAPD) showed some benefits for children, but had higher complication and mortality rates compared to chronic hemodialysis, requiring further evaluation.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Chronic kidney disease (CKD) management in children requires effective renal replacement therapies.
- Continuous ambulatory peritoneal dialysis (CAPD) and chronic hemodialysis (CHD) are primary treatment options.
Purpose of the Study:
- To compare the clinical outcomes and complications of CAPD versus CHD in pediatric patients.
- To evaluate the efficacy and safety of CAPD in children over a 5.5-year period.
Main Methods:
- A comparative study involving 51 children on CAPD and 25 children on CHD.
- Clinical parameters, linear growth, and complications were monitored over 5.5 years.
Main Results:
- CAPD patients exhibited higher hematocrit, serum carbon dioxide, and cholesterol, but lower BUN, albumin, and blood pressure than CHD patients.
- Linear growth showed mixed results between the two groups.
- CAPD patients experienced significantly more complications, including peritonitis and peritoneal catheter failures, and a higher mortality rate.
Conclusions:
- While CAPD demonstrated some advantages in pediatric patients, its high complication and mortality rates necessitate further investigation.
- Careful consideration and further evaluation are crucial for optimizing CAPD therapy in children.
Abstract:
The clinical course of 51 children, 0.2 to 20 years, treated with CAPD, and 25 children, 3 to 18 years, treated with chronic hemodialysis was compared over a 5 1/2 year period. The CAPD patients had higher hematocrit levels, higher serum carbon dioxide and cholesterol levels, lower BUN and serum albumin levels, and lower blood pressure levels than the hemodialysis patients. Linear growth was better in the CAPD patients with one method of assessment, but not with another. Complications were more frequent in the CAPD patients; the peritonitis rate was one episode per 7.2 patient-months and there were 46 failures of peritoneal catheters compared with 12 failures of hemodialysis access. Five CAPD patients died and seven transferred to hemodialysis, whereas one hemodialysis patient died and four transferred to CAPD. Although some advantages of CAPD were demonstrated in this study, the high complication rate and unexpectedly high mortality rate observed with CAPD were disturbing and indicate the need for further evaluation of this form of therapy.