Chronic peritoneal dialysis in Chinese infants and children younger than two years

Chan, Eugene Yu-hin; LT, Alison; Tong, Pc; Lai, Wm; Tse, Niko KC

doi:10.12809/hkmj154781

Cited by 5 publications

(8 citation statements)

References 19 publications

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“…This is consistent with the data published by others [1,4,6,8,10]. In contrast, a Chinese cohort of nine children starting RRT below 2 years of age showed a satisfactory weight gain but a decline in height SDS from À0.7 SDS at PD initiation to À1.4 SDS at the end of follow-up [10]. Only three patients were treated by rGH at the end of PD in our cohort; we believe that optimisation of nutritional status is most of the time sufficient to ensure growth catch-up in this age group [8].…”

Section: Discussionsupporting

confidence: 94%

“…In terms of growth, our report shows a slight increase of median height SDS during PD. This is consistent with the data published by others [1,4,6,8,10]. In contrast, a Chinese cohort of nine children starting RRT below 2 years of age showed a satisfactory weight gain but a decline in height SDS from À0.7 SDS at PD initiation to À1.4 SDS at the end of follow-up [10].…”

Section: Discussionsupporting

confidence: 92%

“…Children who start RRT within the first months of life have more clinical complications, an increased risk of peritonitis and more technical failure of dialysis compared to children who start RRT later [1][2][3][4][5]. Besides, comorbidities are more prevalent in this population with coexisting extrarenal involvement due to primary disease, making prenatal counselling more complicated [1][2][3][4][5][6][7][8][9][10][11]. As summarised in Table 1, long-term data outcomes are scarce, raising the ethical issues whether PD in neonates is justified and leading to different managements between centres [12].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Dachy

Bacchetta

Sellier‐Leclerc

et al. 2020

Néphrologie & Thérapeutique

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Background. -Little data are available for infants who started renal replacement therapy before 6 months of age. Because of extra-renal comorbidities and uncertain outcomes, whether renal replacement therapy in neonates is justified remains debatable. Methods. -We performed a retrospective analysis of all patients who began chronic peritoneal dialysis below 6 months between 2007 and 2017 in two tertiary centres. Results are presented as median (min;max). Results. -Seventeen patients (10 boys) were included (8 prenatal diagnoses, 6 premies), with the following diagnoses: congenital anomalies of kidney and urinary tract (n = 9), oxalosis (n = 5), congenital nephrotic syndrome (n = 2) and renal vein thrombosis (n = 1). Five patients had associated comorbidities. At peritoneal dialysis initiation, age was 2.6 (0.1;5.9) months, height-standard deviation score (SDS) À1.3 (À5.7;1.6) and weight-SDS À1.4 (À3.6;0.6). Peritoneal dialysis duration was 12 (2;32) months, and at peritoneal dialysis discontinuation height-SDS was À1.0 (À4.3;0.7) weight-SDS À0.7 (À3.2;0.2), parathyroid hormone 123 (44;1540) ng/L, and hemoglobin 110 (73;174) g/L. During the first 6 months of peritoneal dialysis, the median time of hospitalisation stay was 69 (15;182) days. Ten patients presented a total of 27 peritonitis episodes. Reasons for peritoneal dialysis discontinuation were switch to hemodialysis (n = 6), transplantation (n = 6), recovery of renal function (n = 2) and death (n = 1). After a follow-up of 4.3 (1.7;10.3) years, 12 patients were transplanted, 2 patients were still on peritoneal dialysis, 2 patients were dialysis free with severe chronic kidney disease and 1 patient had died. Seven patients displayed neurodevelopmental delay, of whom five needed special schooling. Conclusion. -We confirm that most infants starting peritoneal dialysis before 6 months of age will be successfully transplanted and will have a favourable growth outcome. Their quality of life will be impacted by recurrent hospitalisations and neurodevelopmental delay is frequent.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Dachy

Bacchetta

Sellier‐Leclerc

et al. 2020

Néphrologie & Thérapeutique

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“…Mekahli et al 26 showed that growth in infants on PD was affected by comorbid conditions. A study from Hong Kong showed that there was no improvement in the height standard deviation scores (SDS) at 1-and 2-year follow-up 27 and this is comparable to our study. A Polish study showed that infants had poor growth on follow-up.…”

Section: Discussionsupporting

confidence: 89%

Clinical and dialysis outcomes of manual chronic peritoneal dialysis in low-body-weight children from a low-to-middle-income country

2020

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Background: Peritoneal dialysis (PD) is the preferred modality of renal replacement therapy in children with end-stage renal disease (ESRD). In developing countries, the challenges of initiating and sustaining chronic peritoneal dialysis (CPD) are many and are not well-described in the literature. Methods: This was a retrospective study of children aged 0–18 years on manual PD. The objective was to compare the clinical (growth) and dialysis outcomes (dialysis adequacy and peritonitis rates) in young children with low body weight (LBW; ≤15 kg) on CPD with children weighing >15 kg. Results: We found that at baseline, the dialysis prescription, sociodemographic parameters, and the prevalence of complications of ESRD were similar in both groups. On follow-up, however, growth was significantly more affected in LBW children than the rest of the cohort. The adequacy of dialysis and peritonitis rates were comparable between groups. Conclusions: Despite all the challenges, manual CPD is a feasible modality of dialysis in young children with LBW, and their outcomes are comparable to older children even in low-to-middle-income countries. Appropriate early management of associated complications and improving dialysis adequacy are necessary to improve the outcomes in these children.

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“…Maguk az életkor-specifikus alapbetegségek természete (renalis malformatiók), a 10 kg vagy két év alatt ritkán kivitelezhető transzplantáció és a csecsemőkorban általánosan magasabb peritonitiselőfordulási ráta tehető ezért felelőssé. Utóbbi esetben a katéter pelenkavonal fölötti pozicionálása, antibiotikus profilaxissal (Staphylococcus aureus ellen) és a szülők megfelelő oktatásával ez az arány, így a kockázat is csök-kenthető [8,9]. Újabb, nagy esetszámú vizsgálatok az elmúlt években fejlődésről számoltak be ezen a téren a PD-kezelés alatt álló csecsemők eredményeivel kapcsolatban.…”

Section: Megbeszélésunclassified

Peritonealis dialízis gyermekkorban. A Semmelweis Egyetem I. Gyermekgyógyászati Klinikájának eredményei

et al. 2017

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Bevezetés, célkitűzés, módszer: A Semmelweis Egyetem I. Gyermekgyógyászati Klinikája hazánk legnagyobb, krónikus veseelégtelen gyermekeket ellátó centruma, ahol kiemelt szerepet kap a peritonealis dialízis alkalmazása. 2010 és 2017 között a Nemzetközi Gyermek Peritonealis Dialízis Regiszter keretében prospektív adatgyűjtés kapcsán elemeztük kezelési gyakorlatunkat. Eredmények: A fenti időszak 39 betegének átlagéletkora a kezelés indításakor 9,3 ± 6,6 év, a dialíziskezelésen töltött idő 1,3 ± 1,3 év. Veseelégtelenségük hátterében álló vezető okok a glomerulopathiák és a vese/húgyutak fejlődési rendellenességei voltak. Centrumunkban magas arányban megfigyelhetők komorbiditások, szindrómák. 18 betegünknél diagnosztizáltunk peritonitist. Laborértékeinkben eltérést az ajánlott tartományoktól parathormon-és foszfátértékekben tapasztaltunk. Gyógyszerelési statisztikáink megfeleltek az ajánlásoknak, bár bizonyos szerek hazánk-ban gyermek betegek számára nem elérhetőek. Betegeink rövid dialízisen töltött ideje a gyors transzplantációnak köszönhető. A ritka betegségek és számos komorbiditás megjelenésének oka, hogy klinikánk kiemelt gyermeknefrológiai centrum. Következtetés: Gyakorlatunk megfelel a nemzetközi irányelvekben foglaltaknak, az eltérések esetében kezeléseink egyéni átgondolására volt szükség. A nemzetközi regiszterben való részvétel saját gyakorlatunk elemzése és a terület fejlődése szempontjából kiemelt jelentőségű. Orv Hetil. 2017; 158(46): 1831-1840. Kulcsszavak: peritonealis dialízis, peritonitis, transzplantáció, dialízis, IPPN Pediatric peritoneal dialysis 1st Department of Paediatrics, Semmelweis University resultsIntroduction, aim and method: At the 1st Department of Paediatrics, Semmelweis University -the largest center for treating children with chronic kidney disease in Hungary -peritoneal dialysis has a leading role. Between 2010-2017, while being part of the International Pediatric Dialysis Network, we collected and analyzed our data in a prospective study. Beside our patients' basic data, we registered medication statistics, treatment-and laboratory results every 6 months. Results: During this period we had 39 patients on peritoneal dialysis, the average age of dialysis-initiation was 9.3 ± 6.6 years, with 1.3 ± 1.3 years spent on dialysis. The most common causes of ESRD were glomerulopathies and renal-/urinary malformations. A high rate of comorbidities was found, and in 13 cases complex syndromes. Many patients' height-and BMI SDS values differed from the normal for their age. Average glucose-monohydrate concentration was 1.6 ± 0.2%. During our investigation we used lactate-based, acidic or neutral (balanced) dialysates. Between 2010-2017 we diagnosed peritonitis in 18 of our cases. The patients were hospitalized average 70.5 ± 97.7 days. There were differences from the normal range for age in PTH-and phosphate values. Drug-statistics met the requirements of recommendations, though some medications are not available for children in Hungary. The short time spent on dialysis is due to fast-and al...

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Chronic peritoneal dialysis in Chinese infants and children younger than two years

Cited by 5 publications

References 19 publications

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres

Clinical and dialysis outcomes of manual chronic peritoneal dialysis in low-body-weight children from a low-to-middle-income country

Peritonealis dialízis gyermekkorban. A Semmelweis Egyetem I. Gyermekgyógyászati Klinikájának eredményei

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