The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital

Abstract

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge.Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital.Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes.Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively.Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in childrenKeywords: Peritoneal dialysis; renal replacement therapy; acute kidney injury; children; dialysate; developing country.

The State of Paediatric Dialysis: Is the Story Different at Federal Medical Center, Asaba, South-South Nigeria?

“…The study in Kano Nigeria [6] observed AGN as the most common AKI etiology requiring RRT and AGN was a prominent cause also found in other studies. [9,15,16] Haemolysis-associated hemoglobin cast nephropathy was documented in other studies [5,14]. Sepsis was the most common cause of AKI in RRT patients as observed in some other studies in Nigeria [8,10,[14][15][16] Ghana, [9] Pakistan [11], and Turkey [13] unlike in this index study where it constituted only 10% of cases and less prominent in other studies in Nigeria [5].…”

“…The outcome of the children with AKI who had acute dialysis had varied responses ranging from full recovery, inpatient mortality, and progression to ESRD requiring chronic dialysis to undetermined due to loss of follow-up [6,7,11,[14][15][16][17]. Pediatric patients with both AKI and CKD require RRT during their management.…”

“…In different parts of Nigeria, several children with AKI had acute dialysis during their management [5,6,10]. The common etiologies of AKI in these children were sepsis, gastroenteritis, malaria, primary renal disorder, acute glomerulonephritis (AGN), and hemolytic uraemic syndrome (HUS) [4][5][6][7][9][10][11][12][13][14]. Other studies documented metabolic disorders, congenital cardiopathy, tumor lysis syndrome, intoxication, and pigment nephropathy [5,7,13,14].…”

“…The common etiologies of AKI in these children were sepsis, gastroenteritis, malaria, primary renal disorder, acute glomerulonephritis (AGN), and hemolytic uraemic syndrome (HUS) [4][5][6][7][9][10][11][12][13][14]. Other studies documented metabolic disorders, congenital cardiopathy, tumor lysis syndrome, intoxication, and pigment nephropathy [5,7,13,14]. For children with ESRD stage of CKD, the common underlying etiology includes chronic glomerulonephritis (CGN), nephrotic syndrome, sickle cell anemia, and HIV infection [4][5][6].…”

“…For children with ESRD stage of CKD, the common underlying etiology includes chronic glomerulonephritis (CGN), nephrotic syndrome, sickle cell anemia, and HIV infection [4][5][6]. There is a wide range of indications for acute dialysis as documented by several studies [4,5,11,14] ] including azotemia, severe oliguria, and anuria, fluid retention (with peripheral and pulmonary edema, severe unresponsive hypertension, dyselectrolytemia, bleeding diathesis and neurologic abnormalities.…”