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Continuous ambulatory peritoneal dialysis in pediatric patients: a 20-month experience
Insights
Continuous, ambulatory peritoneal dialysis (CAPD) is a viable treatment for pediatric end-stage renal disease (ESRD). While it effectively manages hypertension and reduces transfusion needs, growth velocity remains a concern, necessitating further research.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- End-stage renal disease (ESRD) poses significant challenges for pediatric patients.
- Continuous, ambulatory peritoneal dialysis (CAPD) offers a potential treatment modality.
Purpose of the Study:
- To evaluate the efficacy and outcomes of CAPD in children with ESRD.
- To assess key clinical parameters including biochemical markers, hypertension control, transfusion needs, growth, and peritonitis incidence.
Main Methods:
- A cohort of 36 pediatric patients with ESRD underwent CAPD between August 1980 and May 1982.
- Dialysis involved four to five exchanges daily.
- Clinical data including serum urea, creatinine, blood pressure, transfusion requirements, growth velocity, and peritonitis episodes were collected and analyzed.
Main Results:
- CAPD effectively controlled hypertension in 34 of 36 patients without medication.
- Transfusion requirements were minimal (0.20 U/month) in nephric patients.
- Mean serum urea and creatinine levels were 75 +/- 24 mg/dl and 9.2 +/- 3.1 mg/dl, respectively.
- Despite dialysate glucose, total energy intake was suboptimal in most patients, leading to a mean growth velocity of 0.35 cm/month, with only 4 of 17 patients showing normal growth.
- The peritonitis incidence was one episode per 12.5 patient months.
- Patient rehabilitation and engagement in age-appropriate activities were excellent.
Conclusions:
- CAPD is an acceptable therapeutic option for children suffering from end-stage renal disease.
- While CAPD demonstrates success in managing hypertension and improving rehabilitation, suboptimal energy intake and impaired growth velocity require attention and further investigation.
Abstract:
Thirty-six patients aged 1.6 to 18.8 years with end-stage renal disease (ESRD) underwent continuous, ambulatory peritoneal dialysis (CAPD) between August, 1980, and May, 1982. With four or five exchanges daily, the mean serum urea and creatinine levels were 75 +/- 24 mg/dl and 9.2 +/- 3.1 mg/dl, respectively, hypertension was controlled in 34 of 36 patients without antihypertensive medications, and transfusion requirements were minimal in nephric patients (0.20 U/month). Despite added energy intake from dialysate glucose absorption, the total energy intake was suboptimal in most patients. The mean growth velocity was only 0.35 cm/month and only 4 of 17 patients observed for more than 6 months exhibited normal growth velocity. The incidence of peritonitis was one episode every 12.5 patient months. Rehabilitation was excellent with all patients engaged in age-appropriate activities. CAPD appears to be an acceptable therapeutic modality for children with ESRD.