Related Experiment Videos
Peritoneal dialysis in children under 5 years of age
T M Hölttä1, K A Rönnholm, H Jalanko
1Division of Pediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Finland.
Insights
Maintenance peritoneal dialysis (PD) is a safe and feasible treatment for small children, showing good growth and low mortality. Key challenges include nutrition, peritonitis, and fluid management.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Dialysis Techniques
Background:
- Maintenance peritoneal dialysis (PD) is an option for pediatric end-stage renal disease.
- Limited data exists on PD in very young children.
Purpose of the Study:
- To evaluate the feasibility and safety of maintenance peritoneal dialysis (PD) in children under five years old.
- To assess outcomes including growth, complications, and mortality.
Main Methods:
- Retrospective analysis of 34 children under 5 years old treated with continuous peritoneal dialysis (CPD) between 1986 and 1994 in Finland.
- Data collected on primary renal disease, treatment duration, hospitalizations, complications, and growth parameters.
Main Results:
- Congenital nephrotic syndrome was the most common indication (27/34).
- Mean age at onset was 1.6 years; median treatment time was 9.3 months.
- Hospitalization days decreased significantly. Mortality was 5.9%. Peritonitis rate was 1:11.5 patient-months. Hernias occurred in 29%. Significant improvement in height standard deviation score (hSDS) was observed (p < 0.0001).
Conclusions:
- Peritoneal dialysis is a feasible and safe treatment option for small children.
- Low mortality and good growth were observed.
- Challenges include optimizing nutrition, preventing peritonitis, and managing fluid balance.
Objective:
We report our experience with maintenance peritoneal dialysis (PD) in small children.
Design:
This is a retrospective analysis of the patient records of all children under the age of 5 years treated with continuous peritoneal dialysis (CPD) between 1986 and 1994 in Finland.
Setting:
Treatment was started and the patients were seen at the outpatient clinic at the Hospital for Children and Adolescents, University of Helsinki, every 3 months. Between these visits, they had controls at their local hospital every 2-4 weeks.
Patients:
The most common primary renal disease in these 34 patients was congenital nephrotic syndrome of the Finnish type (27 patients). Others were: congenital nephrotic syndrome (3 patients), polycystic kidney disease (1), urethral valve (1), neuroblastoma (1), and renal dysplasia (1).
Results:
Mean age at onset was 1.6 years and median treatment time 9.3 months. Time spent in hospital decreased from 270 days/year in the 1980s to 150 days/year in the 1990s. Two children died (5.9%). The peritonitis rate on continuous cyclic peritoneal dialysis was 1:11.5 patient-months. Hernias were diagnosed in 29% of the patients. After 3 months half of the patients were on antihypertensive medication. Pulmonary edema was diagnosed once in 12 patients and twice in 2 patients. During the first 6 months on PD the mean height standard deviation score (hSDS) increased from -2.13 to -1.66 (p < 0.0001). The 6-month change in hSDS before initiation and 6 months after the start of CPD increased from -0.12 +/-0.68 to +0.59 +/- 0.64 (p = 0.0008).
Conclusions:
Our results indicate that peritoneal dialysis is feasible and safe in small children. Mortality was low and growth was good. The major challenges presented by CPD therapy were maintenance of optimal nutrition, avoidance of peritonitis, and control of volemia.