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Dialysis for paediatric acute kidney injury in Cape Town, South Africa
Mignon I McCulloch1,2, Valerie A Luyckx3, Brenda Morrow3
1Red Cross War Memorial Children's Hospital (RCWMCH), Rondebosch, Cape Town, South Africa. Mignon.mcculloch@uct.ac.za.
Insights
A "peritoneal dialysis (PD) first" policy for pediatric acute kidney injury (AKI) is feasible in low-resource settings. While PD is effective, survival rates were lower in infants compared to older children, with extracorporeal dialysis showing superior survival.
Area of Science:
- Pediatric Nephrology
- Renal Medicine
- Public Health
Background:
- Access to lifesaving dialysis for acute kidney injury (AKI) is limited in low-resource settings.
- A
- peritoneal dialysis (PD) first
- policy is a more feasible approach for pediatric AKI than hemodialysis in resource-limited environments.
Purpose of the Study:
- To evaluate the feasibility and outcomes of a
- PD first
- policy for pediatric AKI in a low-resource setting.
- To compare the effectiveness and complications of PD versus extracorporeal dialysis (ECD) in children with AKI.
Main Methods:
- Retrospective review of pediatric patients with AKI who received dialysis between 1998 and 2020.
- Analysis of dialysis modalities (PD vs. ECD), patient demographics, catheter insertion methods, complications, and survival rates.
- Comparison of outcomes based on age groups (neonates, infants, older children) and dialysis modality.
Main Results:
- Out of 593 children with AKI, 78.1% received PD first, predominantly younger children and infants.
- PD catheters were mainly inserted by pediatricians at the bedside using Seldinger soft catheters, with a 22.7% complication rate.
- Overall survival was 57.8%, with significantly lower survival in neonates (47.5%) and infants (49.2%) compared to older children (70.4%). Survival was superior in the ECD group (75.4%) versus the PD group (55.6%).
Conclusions:
- The
- PD first
- approach is a valuable and feasible strategy for managing pediatric AKI in low-resource settings.
- Bedside PD catheter insertion can be safely taught and performed, offering an acceptable dialysis modality for children who might otherwise not survive.
- While PD is feasible, careful consideration of patient age and modality selection is crucial, as ECD demonstrated superior survival rates in this cohort.
Background:
Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings.
Methods:
Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020.
Results:
Of the 593 children with AKI who received dialysis, 463 (78.1%) received PD first. Median age was 9.0 (range 0.03-219.3; IQR 13.0-69.6) months; 57.6% were < 1 year old. Weights ranged from 0.9 to 2.0 kg (median 7.0 kg, IQR 3.0-16.0 kg); 38.6% were < 5 kg. PD was used more in younger children compared to extracorporeal dialysis (ECD), with median ages 6.4 (IQR 0.9-30.4) vs. 73.9 (IQR 17.5-113.9) months, respectively (p = 0.001). PD was performed with Seldinger soft catheters (n = 480/578, 83%), predominantly inserted by paediatricians at the bedside (n = 412/490, 84.1%). Complications occurred in 127/560 (22.7%) children receiving PD. Overall, 314/542 (57.8%) children survived. Survival was significantly lower in neonates (< 1 month old, 47.5%) and infants (1-12 months old, 49.2%) compared with older children (> 1 year old, 70.4%, p < 0.0001). Survival was superior in the ECD (75.4%) than in the PD group (55.6%, p = 0.002).
Conclusions:
"PD First for Paediatric AKI" is a valuable therapeutic approach for children with AKI. It is feasible in low-resourced settings where bedside PD catheter insertion can be safely taught and is an acceptable dialysis modality, especially in settings where children with AKI would otherwise not survive.
