New perspectives for PD in acute renal failure related to new catheter techniques and introduction of APD
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Published on: July 20, 2022
J Vande Walle1, A Raes, D Castillo
1University Hospital, Gent, Belgium.
Insights
Automated peritoneal dialysis (APD) is an effective treatment for acute renal failure in pediatric intensive care unit patients. This method offers good ultrafiltration and clearance with a low complication rate, making it a viable alternative to continuous veno-venous dialysis.
Area of Science:
- Pediatric Nephrology
- Intensive Care Medicine
- Renal Replacement Therapy
Background:
- Acute renal failure (ARF) is a significant challenge in pediatric intensive care units (PICUs).
- Peritoneal dialysis (PD) is often recommended for pediatric patients under 20 kg, but continuous veno-venous dialysis/hemofiltration is frequently used instead due to concerns about workload, catheter issues, peritonitis, and ultrafiltration.
- Automated PD (APD) offers potential advantages in managing pediatric ARF.
Purpose of the Study:
- To evaluate the efficacy and safety of automated peritoneal dialysis (APD) as an initial treatment for acute renal failure in pediatric intensive care unit patients.
- To compare APD with continuous veno-venous dialysis in terms of complications, workload, and patient outcomes.
Main Methods:
- A retrospective study was conducted between 1992 and 1995 involving 46 pediatric patients (3 days to 14 years) with ARF.
- Automated PD (APD) was the primary treatment modality for 44 patients, utilizing Seldinger-placed Cook (pleuropericard) catheters.
- Data on catheter-related complications, ultrafiltration (UF), peritonitis, and overall patient management were analyzed.
Main Results:
- APD was successfully used as the initial treatment in 44 out of 46 patients.
- Complications associated with the Cook catheter were minimal, including leakage (1/44), obstruction/dislocation (4/44), and peritonitis (1/44 - Candida).
- APD demonstrated good ultrafiltration, improved clearance, and did not interfere with hemodynamic or respiratory stability, while reducing nursing workload.
Conclusions:
- Automated peritoneal dialysis (APD) is a safe and effective alternative to continuous veno-venous dialysis for pediatric patients with acute renal failure in the ICU.
- The Seldinger-placed pigtail catheter facilitates a quick and safe procedure with a low risk of leakage and peritonitis.
- APD enables efficient fluid management and solute clearance, making it a valuable therapeutic option in pediatric critical care.
Abstract:
Acute renal failure remains a major problem in pediatric intensive care unit (PICU) patients. Although in most handbooks peritoneal dialysis (PD) is still considered to be the first choice for children < 20 kg and there is some evidence that PD may preserve and/or favor recuperation of renal function, most PICU departments are using continuous veno-venous hemofiltration and dialysis or hemodialysis as treatment. The main reasons for this are workload for the PICU nurses, catheter problems, the risk of peritonitis, and limited ultrafiltration. In a retrospective study (1992-1995) in 46 patients (age 3 days to 14 years), automated PD (APD) was the initial treatment in 44 patients. Complications of the Seldinger-placed Cook (pleuropericard) catheter were limited: leakage (1/44); bleeding: n = 0; obstruction or dislocation: n = 4; peritonitis: n = 1 (Candida); ultrafiltration (UF) problems: n = 3. APD in children with acute renal function (ARF) is a good alternative for continuous veno-venous dialysis. Placement of a pigtail (Cook) catheter is a quick (10 min), safe procedure, with low leakage risk. This, together with the low manipulation rate, gives a low peritonitis rate. The use of the cycler makes frequent changes of small volumes possible, resulting in better clearance, good UF, no interference with hemodynamic or respiratory stability, and a reduced workload.
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