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Continuous peritoneal dialysis for children: a decade of worldwide growth and development
1University of Texas Southwestern Medical Center, Department of Pediatrics, Dallas.
Insights
Continuous peritoneal dialysis, including continuous ambulatory peritoneal dialysis (CAPD) and continuous cycler peritoneal dialysis (CCPD), has seen dramatic worldwide growth for pediatric end-stage renal disease patients. This therapy is now a leading treatment option for children awaiting kidney transplants.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Renal Replacement Therapy
Background:
- End-stage renal disease (ESRD) in children necessitates renal replacement therapy.
- Continuous peritoneal dialysis (CPD) modalities, including CAPD and CCPD, have emerged as significant treatment options.
- The past decade has witnessed a substantial global increase in CPD use for pediatric ESRD.
Purpose of the Study:
- To review the worldwide expansion of continuous peritoneal dialysis (CPD) for pediatric patients with end-stage renal disease.
- To document the growth trends of CAPD and CCPD in various global regions over the past decade.
- To highlight the suitability of CPD for young children and infants awaiting transplantation.
Main Methods:
- A comprehensive review of existing literature and data on pediatric dialysis.
- Analysis of trends in the adoption of CAPD and CCPD in different countries and regions.
- Examination of the growth patterns of CPD use from before 1982 to the end of 1989.
Main Results:
- CPD use in pediatric ESRD patients has expanded dramatically worldwide in the last decade.
- By 1989, CAPD/CCPD accounted for 50-75% of pediatric dialysis patients in the US, Canada, and Australia/New Zealand.
- European growth varied, with some countries showing high adoption (46-70%) and others lower (10-20%).
- CPD use is beginning in Japan, with potential for long-term data in the future.
Conclusions:
- Continuous peritoneal dialysis (CAPD/CCPD) is a successful and increasingly utilized renal replacement therapy for pediatric ESRD.
- The majority of children, particularly infants and very young children, can be effectively treated with CPD while awaiting transplantation.
- The significant global growth suggests CPD is a preferred short-term (several years) treatment modality for pediatric ESRD.
Abstract:
This review surveys the dramatic worldwide expansion of the use of continuous peritoneal dialysis as maintenance renal replacement therapy for children with end-stage renal disease that has occurred during the past decade. Before 1982, fewer than 100 pediatric patients had been treated with continuous ambulatory peritoneal dialysis (CAPD), and continuous cycler peritoneal dialysis (CCPD) for children was virtually unknown. By the end of 1989 CAPD/CCPD was accounting for 50% of pediatric dialysis patients (less than 15 years old) in the United States, 65% in Canada, and 75% in Australia/New Zealand. Growth of CAPD/CCPD for children in Europe overall has been less spectacular, but there is wide variability from country to country, with CAPD/CCPD concentrated in eight member countries of the European Dialysis and Transplant Association. Several of these countries (notably the United Kingdom, Israel, the Netherlands and the former Federal Republic of Germany) were treating 46% to 70% of pediatric patients with CAPD/CCPD by the end of 1987. Other European countries such as France and Spain showed little growth of CAPD/CCPD over the decade (10% to 20% of patients treated with CAPD/CCPD). In Japan, CAPD for children has just begun, but because Japanese children are likely to spend longer periods on dialysis awaiting transplantation, information on long-term use of CAPD/CCPD in children may be forthcoming from Japan in the future. No effort is made to compare CAPD/CCPD to hemodialysis as a maintenance therapy for children. The advantages of CAPD/CCPD for the young patient, especially the infant and very young child are noted, and from the past decade of dramatic worldwide growth of CAPD/CCPD in pediatric patients it is inferred that the majority of children, (from 50% to 75%) can be successfully treated with these modalities, at least for the short-term (that is, several years), while awaiting transplantation.