Six Years’ Experience with Continuous Ambulatory Peritoneal Dialysis and Chronic Hemodialysis in Saudi Children

Abstract

Eighty children with End Stage Renal Disease (ESRD) were treated in our unit over a six year period. Forty-eight were treated with CAPD (mean age = 5.8 years) and thirty-two with HD (mean age = 8.2 years). The average duration of treatment was 14.8 months in the CAPD group and 14.2 months in the HD group. There were 22 failures of peritoneal catheter in the CAPD group out of 70 catheters compared to 19 failures of vascular access devices out of 45 in the HD group. Peritoneal catheter failure was due to resistance or recurrent peritonitis in 10 (45.4%) and obstruction in nine (41%), whereas vascular access device failure was due to thrombosis in six (31.5%) and infection in five (26.3%). Fifteen (31.3%) of the CAPD patients died and eight (16.7%) transferred to HD, whereas five (15.6%) HD patients died and four (12.5%) transferred to CAPD. The three year actuarial rates for CAPD were 81% at one year, 55% at two years and 42% at three years, while for HD was 94%, 85% and 64%, respectively. In this unique experience at the Kingdom so far, we found that a fully integrated service of dialysis including both CAPD and HD are essential. Such a system allows the optimal mode of treatment to be chosen for a child at any time and allows the child to move freely from one treatment to another when needed. Ann Saudi Med 1993;13(6) Renal transplantation is the mainstay of treating children with end stage renal disease (ESRD), while dialysis is a way station en route to renal transplantation. In many instances, due to an increasing pool of children with ESRD or shortage of kidneys for transplantation, or choice of nontransplantation, dialysis might be a long-term matter. Several dialysis options have become available now and include hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), continuous cycling peritoneal dialysis (CCPD), and chronic intermittent peritoneal dialysis (IPD). Of the different dialysis options, CAPD and HD are the ones used in this Kingdom [1].In Saudi Arabia, CAPD was the earliest method of treating children with ESRD [2]. However, introduction of Pediatric HD facilities in the late 1980s' was associated with great enthusiasm and according to the National Kidney Foundation (NKF) data, 72.5% of children receiving dialysis therapy now are on HD [1]. Since we have the only independent pediatric HD unit in the Kingdom so far, we therefore weighed the pros and cons of CAPD and HD treatment based upon six years of experience in our center. Patients and MethodsOur CAPD program started in November 1986 and HD in October 1987. All children diagnosed to have ESRD and dialyzed at the Renal Unit of Maternity and Children's Hospital from the start of the programs until the end of December 1992 were included in this study. Eighty children fulfilled these criteria. The selection of children for either CAPD or HD was based on the age, residence, and parents' attitudes. The technique of CAPD and peritoneal catheter care was performed as described previously [3,4]. HD was performed in accordance with publis...

Surgical Outcome of Peritoneal Dialysis Catheter Insertion in Pediatric Patients: An Experience in Iran

“…The outcome was much better than in our center (15,16). A six-year report of dialysis in children from Saudi Arabia, states that 19 out of 48 patients on CAPD had PD failure and the cause was obstruction in half of the cases (17).…”