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[Chronic peritoneal dialysis as home therapy in childhood--risks and complications]
E Kitzmüller1, C Aufricht, G Mürwald
1Universitätsklinik für Kinder- und Jugendheilkunde, AKH Wien, Osterreich.
Insights
Chronic peritoneal home dialysis is effective for children, even infants. Close monitoring and hygiene significantly reduce infection risks, the most common complication in pediatric dialysis.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Chronic Kidney Disease Management
Context:
- Ambulatory peritoneal home dialysis (APHD) is a viable treatment for children.
- The study evaluated APHD complications in pediatric patients over a decade.
- Infants and young children (<6 years) were included, highlighting APHD's applicability across a wide pediatric age range.
Purpose:
- To determine the complications associated with chronic peritoneal home dialysis in children.
- To assess the incidence of peritonitis, exit site infections, and catheter-related issues.
- To compare the safety and efficacy of APHD with other dialysis modalities in pediatric care.
Summary:
- 17 children underwent APHD for an average of 21.7 months.
- Key complications included peritonitis (1:23.1 DM), exit site infections (1:14.8 DM), and catheter issues (1:41.0 DM).
- Hernias occurred in 5 children; 5 transitioned to hemodialysis, and 8 received transplants. Two non-dialysis-related deaths occurred.
Impact:
- Peritoneal dialysis is a suitable home treatment for pediatric patients, including infants.
- Infections are the primary complication, but can be minimized through diligent monitoring and hygiene.
- This study supports APHD as a safe and effective long-term dialysis option for children, reducing reliance on hospital-based treatments.
Background:
The aim of our study was to ascertain the complications of chronic peritoneal home dialysis in childhood.
Patients:
17 children were treated by ambulatory peritoneal home dialysis between 1984 and 1994 at the paediatric dialysis unit of the University Children's Hospital in Vienna, Austria. Their average age was 6.5 years (1 week to 12 years); 7 (41.2%) children were below school age (< 6 years).
Results:
In our observation period of 369 dialysis months (DM), the average duration of dialysis was 21.7 months (4.0-74.3). In relation to total DM the incidence of peritonitis was 1:23.1 of exit site infection 1:14.8 and of catheter related complications 1:41.0. 5 children developed hernias. 5 children were switched to haemodialysis and 8 children received kidney transplants. 2 children died from non-dialysis-associated causes.
Conclusion:
Peritoneal dialysis, in contrast to haemodialysis, is a home treatment modality applicable even to infants. The most common complication is infection. Our data and the European and North American literature show that by close ambulatory monitoring and special hygenic procedures peritonitis frequency can be markedly reduced.