Peritoneal dialysis in children: challenges for the new millennium

Long-Term Peritoneal Dialysis in Infants

Although the numbers of infants requiring dialysis are small, management of these patients presents many challenges. Mortality is high in infants with comorbidities, complications of dialysis are common, and most of these infants need enteral feeding. However, the long-term outcome for otherwise healthy infants is comparable to that for older children.

Successes and pitfalls of chronic peritoneal dialysis in infants - a Polish nationwide outcome study

INTRODUCTION

Peritoneal dialysis (PD) is a preferred method of renal replacement therapy for end-stage renal disease in children. Recent advances have allowed chronic PD to be provided to children of all ages and sizes.

MATERIAL AND METHODS

The study was designed as a national (10 dialysis centres), multicentre retrospective analysis of the medical history of 33 children who started chronic peritoneal dialysis in their infancy between 1993 and 2005, with a follow-up period of at least 24 months.

RESULTS

The nutritional status of the infants was unsatisfactory. The mean SDS of body weight at the start was -2.0, at 1 year of age -1.7. Only 40% of infants were adequately nourished at 1 year of age. Long-term follow-up analysis showed that 12 children received a kidney transplant, 13 were still on dialysis (4 changed method) and 6 died (mortality rate in the first year of life of 9%). In 2 children we observed an improvement of renal function. We observed a relatively high (1/8.8 patient-months) peritonitis rate in the analysed children when compared to 1 : 22 patient-months in all children undergoing PD in Poland.

CONCLUSIONS

The results of our survey have shown that the management of dialysed infants is still a challenge for the medical team and families, but long-term results of the therapy are encouraging.

Management of the neonate with chronic renal failure

The number of infants requiring chronic dialysis is small and has remained stable over the last decade. The majority have structural abnormalities of the urinary tract and over 50% are diagnosed antenatally. Mortality rate is high, particularly in infants with comorbidity, but has been improving. Management presents many challenges: as well as ethical issues, complications of dialysis are common and most infants need enteral feeding. Commitment from the family and medical team is crucial for success. However, the long-term outcome for otherwise healthy infants is comparable to that of older children.