Peritoneal Dialysis in Childhood Acute Kidney Injury: Experience in Southwest Nigeria

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>The choices for renal replacement therapy (RRT) in childhood acute kidney injury (AKI) are limited in low-resource settings. Peritoneal dialysis (PD) appears to be the most practical modality for RRT in young children with AKI in such settings. Data from sub-Saharan Africa on the use of PD in childhood AKI are few.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We performed a retrospective study of children who underwent PD for AKI at a tertiary-care hospital in southwest Nigeria from February 2004 to March 2011 (85 months).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The study included 27 children (55.6% female). Mean age was 3.1 ± 2.6 years, with the youngest being 7 days, and the oldest, 9 years. The causes of AKI were intravascular hemolysis ( n = 11), septicemia ( n = 8), acute glomerulonephritis ( n = 3), gastroenteritis ( n = 3), and hemolytic uremic syndrome ( n = 2). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. Duration of PD ranged from 6 hours to 12 days (mean: 5.0 ± 3.3 days). The main complications were peritonitis ( n = 10), pericatheter leakage ( n = 9), and catheter outflow obstruction ( n = 5). Of the 27 patients, 19 (70%) survived till discharge.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In low-resource settings, PD can be successfully performed for the management of childhood AKI. In our hospital, the use of adapted catheters may have contributed to the high complication rates. Peritoneal dialysis should be promoted for the management of childhood AKI in low-resource settings, and access to percutaneous or Tenckhoff catheters, dialysis fluid, and automated PD should be increased.</jats:p></jats:sec>

Acute Peritoneal Dialysis in African Pediatric Area Experience of Pediatric Nephrology Unit of Yopougon University Hospital (Abidjan, Côte d'Ivoire)

“…The indication of PD in the AKI is strongly influenced by hyperkalemia due to the risk of cardiac arrest by pace disorders and acute lung and cerebral edema leading to salt and water retention. PD was a renal extra purification technique used in our unity because it is the only method available; also, it has the benefit of being just a simple procedure where the peritoneum can be easily hyperpermeable in infants and small children [3] and this all the more the production of vascular first is often difficult. Redon drains have been used in low-weight children (<10 kg) and for which the diameter of the Tenckhoff catheter we had was not suitable.…”

“…Of these two methods, peritoneal dialysis appears to be the most feasible in children in developing countries, because it is cost effective and does not required a high financial status [2,3]. …”

Peritoneal Dialysis for Acute Kidney Injury

“…The relatively good outcomes that have been reported by acute PD programs in very low resource settings have PDI resulted in our recommendation that acute PD can be utilized to treat AKI (6,9,18,51,55,56). A pilot study of acute PD in adults and children conducted in Tanzania between July 2009 and June 2011 included 20 patients and had good outcomes (9).…”

Use of Peritoneal Dialysis in AKI

“…Although there has recently been an increased interest in using PD to treat patients with AKI in low-resource settings (5,6,8,28,37), the use of PD for such patients in developed countries has been extremely limited. This finding may be considered surprising, because it has been postulated that PD may be more physiologic and less inflammatory than EBP, which involves the exposure of blood to synthetic surfaces.…”

“…There has, however, been renewed interest in the use of peritoneal dialysis (PD) in AKI (3,4). Indeed, there has been a recent flurry of publications reporting good results (5)(6)(7)(8).…”