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Continuous ambulatory peritoneal dialysis in children: comparison with hemodialysis
Insights
Continuous ambulatory peritoneal dialysis (CAPD) offers better clinical outcomes like higher hematocrit and lower blood pressure in children compared to hemodialysis. Despite more complications, CAPD is preferred by patients and is more cost-effective.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- End-stage renal disease in children requires renal replacement therapy.
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are primary treatment modalities.
Purpose of the Study:
- To compare the clinical and biochemical effects of CAPD versus HD in pediatric patients.
- To evaluate complications, hospitalization rates, and patient preference.
Main Methods:
- A 2.5-year comparative study involving 20 children on CAPD and 16 children on HD.
- Assessment of hematocrit, serum chemistry, nutritional intake, blood pressure, and transfusion rates.
Main Results:
- CAPD patients showed higher hematocrit, serum CO2, cholesterol, calorie/protein intake, and lower systolic blood pressure and transfusion rates.
- CAPD group experienced more complications, but similar hospitalization rates. CAPD cost was significantly lower than HD.
- Four treatment failures occurred with CAPD versus one with HD.
Conclusions:
- CAPD is a viable and cost-effective alternative to HD for pediatric patients.
- Despite a higher complication rate, CAPD offers significant clinical benefits and patient preference.
Abstract:
The clinical and biochemical effects of continuous ambulatory peritoneal dialysis in 20 children and of hemodialysis in 16 children were compared over a 2 1/2-year period. Statistically significant differences between the treatment groups included higher hematocrit, higher serum carbon dioxide and cholesterol levels, large intake of calories and protein, and lower systolic blood pressure and rates of transfusion in the patients receiving continuous ambulatory peritoneal dialysis. These patients had more complications than the patients receiving hemodialysis, but hospitalization rates in the two groups were similar. The cost of continuous ambulatory peritoneal dialysis was +19,600 per patient-year; the cost of hemodialysis was +54,300 per patient-year; the cost of hemodialysis was +54,300 per patient-year. There were four treatment failures with continuous ambulatory peritoneal dialysis and one with hemodialysis. Patients treated with both forms of dialysis preferred continuous ambulatory peritoneal dialysis. We conclude that continuous ambulatory peritoneal dialysis is an important alternative to hemodialysis in children.