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Published on: July 19, 2018
Outcome of infants on chronic peritoneal dialysis
E N Ellis1, D Pearson, B Champion
1Arkansas Children's Hospital, Little Rock, USA.
Insights
Infants on chronic peritoneal dialysis (PD) face challenges. Mortality risk is higher with low urine output and non-renal health issues in infants under one year old.
Area of Science:
- Pediatric Nephrology
- Infant Health
- Renal Replacement Therapy
Background:
- Chronic peritoneal dialysis (PD) is a renal replacement therapy option for infants.
- Outcomes for infants initiating PD before one year of age require further investigation.
Purpose of the Study:
- To assess the outcomes of infants treated with chronic peritoneal dialysis (PD) initiated before one year of age.
- To identify factors associated with mortality in this vulnerable population.
Main Methods:
- Retrospective review of 21 infants who started PD before 12 months of age.
- Data collected included demographics, primary renal diagnosis, urine output, nutritional status, presence of non-renal abnormalities, and treatment outcomes.
Main Results:
- The most common diagnosis was renal hypoplasia/dysplasia. 11 infants had oliguria, and 12 had non-renal abnormalities.
- Growth parameters (weight, height, head circumference) were often below the fifth percentile despite nutritional support.
- Mortality was significantly higher in infants with oliguria (7 deaths) and those with both renal and non-renal abnormalities (9 deaths).
Conclusions:
- Mortality in infants under one year on PD is associated with oliguria and the presence of non-renal abnormalities.
- Early identification and management of these risk factors are crucial for improving outcomes in infants undergoing PD.
Abstract:
To assess the outcome of infants on chronic peritoneal dialysis (PD), we retrospectively reviewed 21 patients who began PD prior to one year of age. Mean age at first dialysis was 56 +/- 56 days with mean weight of 3.6 +/- 1.6 kg. Seventeen infants were male and 17 were Caucasian. The most common primary renal diagnosis was renal hypoplasia/dysplasia, occurring in 7 infants. Mean time on PD was 10 +/- 10 months. Eleven infants had oliguria, and 10 infants had adequate urine output. All but 1 infant received tube feedings; mean caloric intake was 453 +/- 92 kJ/kg/day. Despite nutritional management, weight, height, and head circumference was at or above the fifth percentile in only 10, 4, and 5 infants, respectively. Nonrenal abnormalities were present in 12 of 21 infants with lung, heart, and central nervous system abnormalities occurring most often. Outcome included 7 receiving renal transplants, 1 who recovered renal function, 4 who continued on PD, and 9 who died. Seven infants with oliguria died, while only 2 infants with adequate urine output died. No infant with isolated renal disease died, while 9 of 12 patients with renal plus nonrenal abnormalities died. Thus mortality in infants less than one year of age on PD appears to be associated with the presence of oliguria and nonrenal abnormalities.
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