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Peritoneal dialysis in infants and children
Insights
Peritoneal dialysis (PD) offers a safer, more comfortable alternative to hemodialysis for pediatric renal failure patients. This study shows PD effectively restored health in 22 children, with high survival rates.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Pediatric renal failure presents unique challenges requiring effective treatment modalities.
- Hemodialysis can be invasive and less comfortable for children.
- Peritoneal dialysis (PD) is an alternative renal replacement therapy for pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of peritoneal dialysis in pediatric patients with acute or chronic renal failure.
- To assess patient outcomes, including survival rates and methods of recovery.
Main Methods:
- Retrospective analysis of 22 pediatric patients treated with peritoneal dialysis (PD) over 3.5 years.
- Utilized adult or pediatric Tenckhoff catheters for PD delivery.
- Monitored for catheter-related infections and mechanical complications.
Main Results:
- Overall survival rate of 82% (18 of 22 patients).
- Catheter-related issues included 7 infections and 8 mechanical problems, requiring intervention.
- Successful outcomes included renal function recovery (6), transplantation (8), and maintenance PD (4).
Conclusions:
- Peritoneal dialysis is a viable and effective treatment for pediatric renal failure.
- PD offers easier, more comfortable, and safer management compared to hemodialysis in children.
- Careful catheter management is crucial for minimizing complications in pediatric PD.
Abstract:
Pediatric renal failure patients can be restored to health with peritoneal dialysis more easily, more comfortably, and more safely than with hemodialysis. During the past 3.5 years, we have treated 22 children with either acute (less than 30 days) or chronic (greater than 30 days) peritoneal dialysis (PD) at Henrietta Egleston Hospital for Children. They ranged in age from 2 weeks to 15 1/6 years, mean 5.2 years. The indications for acute dialysis were renal failure following cardiac surgery (4); hemolytic-uremic syndrome (4); and renal failure associated with bromide intoxication (1), congenital urethral stricture (1), or bronchopulmonary dysplasia (1). Chronic dialysis was utilized for end-stage renal disease caused by glomerulonephritis (5), chronic infection (2), hemolytic-uremic syndrome (1), cystinosis (1), congenital renal artery stenosis (1), and unknown etiology (1). Thirty-four adult or pediatric Tenckhoff catheters were utilized to deliver PD for from 6 to 551 days (18 months). Pediatric Tenckhoff catheters must be pre-measured in order to have the Dacron cuffs glued to the appropriate position on the catheter (7-12 cm from the end) to fit the child. There were seven catheter-related infections in four patients; three required catheter revision and four were treated medically. There were eight catheter-related mechanical problems, all of which required re-operation. All of those on chronic PD and seven of those on acute PD survived for an overall survival of 82 per cent. All surviving patients have been restored to health either by recovery of renal function (6 patients), renal transplantation (8 patients), or maintenance of chronic ambulatory peritoneal dialysis (4 patients).