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Adequacy of chronic peritoneal dialysis in low socioeconomic class uremic children
Insights
Successful rehabilitation in uremic children is achievable with peritoneal dialysis (PD), but requires addressing malnutrition and non-compliance to improve outcomes and reduce mortality. Continuous ambulatory peritoneal dialysis (CAPD) and intermittent PD offer viable treatment options.
Area of Science:
- Pediatric Nephrology
- Renal Rehabilitation
- Dialysis Therapies
Background:
- Uremic children from low socioeconomic backgrounds face unique challenges in rehabilitation.
- Peritoneal dialysis (PD) is a key treatment modality for pediatric end-stage renal disease.
Purpose of the Study:
- To prospectively evaluate the success of rehabilitation in 57 uremic children.
- To assess factors influencing growth, development, complications, compliance, mortality, and overall outcomes.
Main Methods:
- Prospective evaluation of 57 uremic children undergoing dialysis.
- Assessment included growth, development, complications (peritonitis), compliance, mortality, and treatment outcomes.
- Patients were treated with intermittent peritoneal dialysis (PD) or continuous ambulatory peritoneal dialysis (CAPD).
Main Results:
- Overall peritonitis incidence was 5.6 episodes per patient-year.
- 41 patients survived; 12 continued PD, 16 received renal allografts, and 13 switched to hemodialysis.
- Hypervolemia, sepsis, and treatment abandonment caused 16 deaths.
Conclusions:
- Malnutrition and non-compliance significantly impede successful rehabilitation in pediatric uremia.
- Peritoneal dialysis can facilitate rehabilitation, but requires vigilant management of complications and patient adherence.
- Multifactorial approaches are crucial for optimizing outcomes in this vulnerable population.
Abstract:
The ability to provide successful rehabilitation in 57 uremic children from a low socioeconomic background was prospectively evaluated by means of assessment of growth and development, incidence of complications, compliance, mortality rate and final outcome. Forty-three patients were on intermittent peritoneal dialysis (PD) and 14 on continuous ambulatory peritoneal dialysis (CAPD). The overall incidence of peritonitis was 5.6 episodes per patient-year; 41 patients are alive; 12 continue on intermittent dialysis; 16 received a renal allograft and 13 shifted to hemodialysis. Hypervolemia, sepsis due to peritonitis and abandonment of treatment were the main causes of death in 16 children. Malnutrition and non-compliance were the main factors leading to unsatisfactory rehabilitation.