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J Pediatr Intensive Care
DOI: 10.1055/s-0041-1741466
Original Article

Peritoneal Dialysis with Rigid Catheters in Children with Acute Kidney Injury: A Single-Centre Experience

Manasi Garg 
1   Department of Pediatrics, Pondicherry Institute of Medical Sciences, Pondicherry, India
,
Lalitha A. V. 
2   Department of Pediatrics, Pediatric Intensive Care Unit, St. John's Medical College Hospital, Bengarulu, Karnataka, India
,
Anil Vasudevan 
3   Department of Pediatric Nephrology, St. John's Medical College Hospital, Bengarulu, Karnataka, India
› Author Affiliations Funding None.
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Abstract

Peritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36–89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients (n = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.

Keywords

children - peritoneal dialysis - acute kidney injury - rigid catheter


Publication History

Received: 02 September 2021

Accepted: 04 December 2021

Article published online:
07 January 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • References

  • 1 Palmieri T, Lavrentieva A, Greenhalgh D. An assessment of acute kidney injury with modified RIFLE criteria in pediatric patients with severe burns. Intensive Care Med 2009; 35 (12) 2125-2129
    CrossrefPubMedGoogle Scholar
  • 2 Kendirli T, Ekim M, Ozçakar ZB. et al. Renal replacement therapies in pediatric intensive care patients: experiences of one center in Turkey. Pediatr Int 2007; 49 (03) 345-348
    CrossrefPubMedGoogle Scholar
  • 3 Mehta P, Sinha A, Sami A. et al. Incidence of acute kidney injury in hospitalized children. Indian Pediatr 2012; 49 (07) 537-542
    CrossrefPubMedGoogle Scholar
  • 4 Bunchman TE, McBryde KD, Mottes TE, Gardner JJ, Maxvold NJ, Brophy PD. Pediatric acute renal failure: outcome by modality and disease. Pediatr Nephrol 2001; 16 (12) 1067-1071
    CrossrefPubMedGoogle Scholar
  • 5 Krause I, Herman N, Cleper R, Fraser A, Davidovits M. Impact of dialysis type on outcome of acute renal failure in children: a single-center experience. Isr Med Assoc J 2011; 13 (03) 153-156
    PubMedGoogle Scholar
  • 6 Vasudevan A, Iyengar A, Phadke K. Modality of choice for renal replacement therapy for children with acute kidney injury: Results of a survey. Indian J Nephrol 2012; 22 (02) 121-124
    CrossrefPubMedGoogle Scholar
  • 7 Coulthard MG, Crosier J, Griffiths C. et al. Haemodialysing babies weighing <8 kg with the Newcastle infant dialysis and ultrafiltration system (Nidus): comparison with peritoneal and conventional haemodialysis. Pediatr Nephrol 2014; 29 (10) 1873-1881
    CrossrefPubMedGoogle Scholar
  • 8 Ronco C, Garzotto F, Brendolan A. et al. Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM). Lancet 2014; 383 (9931): 1807-1813
    CrossrefPubMedGoogle Scholar
  • 9 Mishra OP, Gupta AK, Pooniya V, Prasad R, Tiwary NK, Schaefer F. Peritoneal dialysis in children with acute kidney injury: a developing country experience. Perit Dial Int 2012; 32 (04) 431-436
    CrossrefPubMedGoogle Scholar
  • 10 Vasudevan A, Phadke K, Yap HK. Peritoneal dialysis for the management of pediatric patients with acute kidney injury. Pediatr Nephrol 2017; 32 (07) 1145-1156
    CrossrefPubMedGoogle Scholar
  • 11 Fine RN. Peritoneal dialysis update. J Pediatr 1982; 100 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 12 Wong SN, Geary DF. Comparison of temporary and permanent catheters for acute peritoneal dialysis. Arch Dis Child 1988; 63 (07) 827-831
    CrossrefPubMedGoogle Scholar
  • 13 Nourse P, Cullis B, Finkelstein F. et al. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics). Perit Dial Int 2021; 41 (02) 139-157
    CrossrefPubMedGoogle Scholar
  • 14 Summary of recommendation statements. Kidney Int Suppl (2011) 2012; 2 (01) 8-12
    CrossrefPubMedGoogle Scholar
  • 15 Cullis B, Abdelraheem M, Abrahams G. et al. Peritoneal dialysis for acute kidney injury. Perit Dial Int 2014; 34 (05) 494-517
    CrossrefPubMedGoogle Scholar
  • 16 Namachivayam SP, Butt W, Millar J, Konstantinov IE, Nguyen C, d'Udekem Y. Early peritoneal dialysis and major adverse events after pediatric cardiac surgery: a propensity score analysis. Pediatr Crit Care Med 2019; 20 (02) 158-165
    CrossrefPubMedGoogle Scholar
  • 17 Westrope CA, Fleming S, Kapetanstrataki M, Parslow RC, Morris KP. Renal replacement therapy in the critically ill child. Pediatr Crit Care Med 2018; 19 (03) 210-217
    CrossrefPubMedGoogle Scholar
  • 18 El Shamy O, Patel N, Abdelbaset MH. et al. Acute start peritoneal dialysis during the COVID-19 pandemic: outcomes and experiences. J Am Soc Nephrol 2020; 31 (08) 1680-1682
    CrossrefPubMedGoogle Scholar
  • 19 Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury in southern India. Indian J Pediatr 2013; 80 (03) 183-189
    CrossrefPubMedGoogle Scholar
  • 20 Choudhary P, Kumar V, Saha A, Thakur A. Peritoneal dialysis in critically ill children in resource-limited setting: a prospective cohort study. Perit Dial Int 2021; 41 (02) 209-216
    CrossrefPubMedGoogle Scholar
  • 21 Cerdá J, Bagga A, Kher V, Chakravarthi RM. The contrasting characteristics of acute kidney injury in developed and developing countries. Nat Clin Pract Nephrol 2008; 4 (03) 138-153
    CrossrefPubMedGoogle Scholar
  • 22 McCulloch MI, Nourse P, Argent AC. Use of locally prepared peritoneal dialysis (PD) fluid for acute PD in children and infants in Africa. Perit Dial Int 2020; 40 (05) 441-445
    CrossrefPubMedGoogle Scholar
  • 23 Kohli HS, Barkataky A, Kumar RS. et al. Peritoneal dialysis for acute renal failure in infants: a comparison of three types of peritoneal access. Ren Fail 1997; 19 (01) 165-170
    CrossrefPubMedGoogle Scholar
  • 24 Ademola AD, Asinobi AO, Ogunkunle OO, Yusuf BN, Ojo OE. Peritoneal dialysis in childhood acute kidney injury: experience in southwest Nigeria. Perit Dial Int 2012; 32 (03) 267-272
    CrossrefPubMedGoogle Scholar
  • 25 Kara A, Gurgoze MK, Aydin M, Taskin E, Bakal U, Orman A. Acute peritoneal dialysis in neonatal intensive care unit: an 8-year experience of a referral hospital. Pediatr Neonatol 2018; 59 (04) 375-379
    CrossrefPubMedGoogle Scholar
  • 26 Anigilaje EA, Fashie AP, Odeyemi B, Yakubu A. Acute peritoneal dialysis in children with acute kidney injury at the University of Abuja Teaching Hospital, Abuja, Nigeria: a report of 12 months experience in a developing country. Afr Health Sci 2020; 20 (01) 314-323
    CrossrefPubMedGoogle Scholar
  • 27 Nkoy AB, Ndiyo YM, Matoka TT. et al. A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program. Perit Dial Int 2020; 40 (05) 504-508
    CrossrefPubMedGoogle Scholar
  • 28 Flynn JT, Kershaw DB, Smoyer WE, Brophy PD, McBryde KD, Bunchman TE. Peritoneal dialysis for management of pediatric acute renal failure. Perit Dial Int 2001; 21 (04) 390-394
    CrossrefPubMedGoogle Scholar
  • 29 Van Biljon G. Causes, prognostic factors and treatment results of acute renal failure in children treated in a tertiary hospital in South Africa. J Trop Pediatr 2008; 54 (04) 233-237
    CrossrefPubMedGoogle Scholar