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Pediatric Emergent Peritoneal Dialysis in Intensive Care Units: Indications, Techniques, and Outcomes
Yi-Hsuan Huang1, Chia-Man Chou2,3,4, Sheng-Yang Huang2,3,4
1Department of Medical Education, Taichung Veterans General Hospital, Taichung City, Taiwan.
Insights
Emergent peritoneal dialysis (PD) in pediatric patients shows high mortality, especially with acute kidney injury (AKI). Prematurity is linked to dialysate leakage, highlighting the need for improved PD management strategies.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Emergent peritoneal dialysis (PD) is a critical intervention for pediatric patients with life-threatening conditions.
- Understanding risk factors is crucial for optimizing outcomes in this vulnerable population.
Purpose of the Study:
- To identify risk factors impacting survival, kidney function recovery, PD duration, complications, and quality of life in pediatric patients undergoing emergent PD.
- To evaluate outcomes associated with emergent PD across various pediatric critical care scenarios.
Main Methods:
- Retrospective review of medical records for pediatric patients receiving emergent bedside PD (January 2010-February 2023).
- Data collected included demographics, preoperative details, and procedural information for 34 catheter placements.
- Statistical analysis performed using MedCalc®, with significance set at p < 0.05.
Main Results:
- The study included a median age of 39 days, with 64.7% males and 17.6% preterm infants.
- Acute kidney injury (AKI) was the primary indication (88.2%). Median PD duration was 7 days.
- High mortality rate (71.4%) observed; complications included dialysate leakage (22.8%) and catheter obstruction (31.4%).
Conclusions:
- Early PD initiation is recommended for pediatric patients post-cardiac surgery.
- AKI is a significant mortality risk factor; prematurity increases dialysate leakage risk.
- Further large-scale prospective studies are needed to refine emergent PD management in pediatric critical care.
Introduction:
This study aimed to identify risk factors affecting outcomes in pediatric patients requiring emergent peritoneal dialysis (PD) for all causes, focusing on survival rates, kidney function recovery, PD duration, complications, and quality of life.
Methods:
A retrospective review was conducted on medical records of pediatric patients who received emergent bedside PD in the intensive care unit from January 2010 to February 2023. Thirty-four catheters were placed, with demographic, preoperative, and procedural data collected. MedCalc® Statistical Software was used for analysis with a significance level set at p < 0.05. Prophylactic antibiotics were administered prior to surgery, and catheters were placed using a consistent technique by a single team of pediatric surgeons.
Results:
The median age at catheter placement was 39 days (range 2-2,286), and the median body weight was 3.53 kg (range 1.2-48.8). The majority were male (64.7%), with 17.6% preterm. The most common indication for PD was acute kidney injury (AKI) (88.2%), followed by hyperammonemia, metabolic acidosis, and abdominal compartment syndrome. The median waiting period for PD placement was 1 day, and the median duration of PD was 7 days. Complications included dialysate leakage (22.8%) and catheter obstruction leading to PD discontinuation (31.4%). The mortality rate was high at 71.4%.
Conclusion:
It is advisable to advocate for the early initiation of PD in pediatric patients following cardiac surgery. AKI is a significant risk factor for mortality, while prematurity increases the risk of dialysate leakage. Omentectomy and the method of catheter exit did not significantly affect outcomes. The study's limitations highlight the need for larger prospective studies to better understand and improve emergent PD management in this vulnerable population.
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