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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.
Insights
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.
Abstract:
Peritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36-89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients ( n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.
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