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Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience
Manasi Garg1, Lalitha A V2, Anil Vasudevan3
1Department of Pediatrics, Pondicherry Institute of Medical Sciences, Pondicherry, India.
Journal of Pediatric Intensive Care
|December 4, 2024
Summary
Peritoneal dialysis (PD) using rigid catheters is a safe and effective treatment for acute kidney injury (AKI) in critically ill children in resource-limited settings, showing improved renal function and survival.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Renal Replacement Therapy
Background:
- Acute kidney injury (AKI) poses a significant challenge in critically ill children, particularly in resource-poor settings.
- Peritoneal dialysis (PD) is often the preferred dialysis modality due to its simplicity and accessibility.
- Evaluating the safety and efficacy of acute PD with rigid catheters in this vulnerable population is crucial.
Purpose of the Study:
- To assess the utility and safety of acute peritoneal dialysis (PD) using rigid catheters in critically ill children.
- To evaluate short-term patient and renal outcomes, as well as complications associated with PD in a pediatric intensive care unit (PICU).
Main Methods:
- A retrospective study analyzed data from 113 critically ill children who underwent acute PD with rigid catheters between 2014 and 2019.
- Outcomes, including renal recovery and survival, and complications were evaluated.
- Patient conditions at PD initiation, such as mechanical ventilation and multiorgan dysfunction syndrome, were recorded.
Main Results:
- Sepsis, dengue infection, and hemolytic uremic syndrome were the most common causes of AKI.
- PD demonstrated effectiveness with significant improvements in urea and creatinine levels.
- One-third of patients (33.6%) achieved complete renal recovery; overall survival was 53.7%.
- Metabolic complications were most frequent (39.8%), with catheter-related complications in 21.2% and peritonitis in 4.4%.
Conclusions:
- Acute PD using rigid catheters is a viable bedside procedure in settings lacking soft catheters.
- Significant solute clearance can be achieved with acceptable complication rates.
- PD offers a valuable renal replacement therapy option for critically ill children with AKI in resource-limited environments.
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