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Clinical experience in the treatment of infants with chronic peritoneal dialysis
E Verrina1, G Zacchello, F Perfumo
1Italian Registry of Pediatric Chronic Peritoneal Dialysis, Italy.
Insights
Chronic peritoneal dialysis (CPD) is a viable treatment for infants with end-stage renal failure, despite higher risks. This study shows satisfactory outcomes and improved growth in infants undergoing CPD.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Infants with end-stage renal failure present unique clinical and technical challenges for dialysis.
- Chronic peritoneal dialysis (CPD) is often the initial treatment for this population.
Purpose of the Study:
- To evaluate the outcomes of CPD in infants under one year of age.
- To compare infant CPD outcomes with those of older children.
Main Methods:
- Analysis of data from a National Registry on 22 infants starting CPD before age one.
- Comparison of patient and technique survival, peritonitis incidence, catheter-related complications, and statural growth with older children.
Main Results:
- Patient survival was 89.1% at 1 year and 82.2% at 2 years, lower than older children.
- Technique survival was 89.1% at 1 year and 77.1% at 2 years.
- Statural growth showed significant improvement between the first and second year of CPD.
Conclusions:
- Infants undergoing CPD represent a higher-risk group but can be treated satisfactorily.
- CPD is a suitable option for infants awaiting renal transplantation.
Abstract:
Chronic peritoneal dialysis (CPD) is the first treatment modality for most infants with end-stage renal failure; this group of patients shows peculiar clinical and technical problems. We present the data from a National Registry on 22 children starting CPD under one year of age, representing 11.6% of the total population of the Registry (189 patients). Mean weight at start of CPD was 6.1 +/- 1.8 kg and duration of dialysis was 22.1 +/- 15.5 months. During the follow-up period, 9 patients were transplanted, 1 was shifted to hemodialysis, and 4 died. Patient survival was 89.1% and 82.2% at 1 and 2 years (97.9% and 96.5% in the group of 167 older children); technique survival results were 89.1% at 1 year and 77.1% at 2 years (vs 92.5% and 85.7%, respectively). The incidence of peritonitis was 1 episode every 15.6 CPD-months (1:16.1 in the older children). Catheter-related complications occurred more frequently in infants (1:11.8 vs 1:17 episode:CPD-months), even if this difference was not statistically significant. Statural growth was on average -0.29 +/- 0.66 SD/year with a significant improvement between the first (-0.50 +/- 0.79) and the second (+0.23 +/- 0.77) year of CPD. Our data confirm that infants represent a higher risk group and that they can be treated satisfactorily with CPD while awaiting renal transplantation.