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Huang YH, Chou CM, Huang SY, Chen HC. Pediatric Emergent Peritoneal Dialysis in Intensive Care Units: Indications, Techniques, and Outcomes. Blood Purif 2024:1-10. [PMID: 38797161 DOI: 10.1159/000539512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION This study aimed to identify risk factors affecting outcomes in pediatric patients requiring emergent peritoneal dialysis (PD) for all causes, focusing on survival rates, kidney function recovery, PD duration, complications, and quality of life. METHODS A retrospective review was conducted on medical records of pediatric patients who received emergent bedside PD in the intensive care unit from January 2010 to February 2023. Thirty-four catheters were placed, with demographic, preoperative, and procedural data collected. MedCalc® Statistical Software was used for analysis with a significance level set at p < 0.05. Prophylactic antibiotics were administered prior to surgery, and catheters were placed using a consistent technique by a single team of pediatric surgeons. RESULTS The median age at catheter placement was 39 days (range 2-2,286), and the median body weight was 3.53 kg (range 1.2-48.8). The majority were male (64.7%), with 17.6% preterm. The most common indication for PD was acute kidney injury (AKI) (88.2%), followed by hyperammonemia, metabolic acidosis, and abdominal compartment syndrome. The median waiting period for PD placement was 1 day, and the median duration of PD was 7 days. Complications included dialysate leakage (22.8%) and catheter obstruction leading to PD discontinuation (31.4%). The mortality rate was high at 71.4%. CONCLUSION It is advisable to advocate for the early initiation of PD in pediatric patients following cardiac surgery. AKI is a significant risk factor for mortality, while prematurity increases the risk of dialysate leakage. Omentectomy and the method of catheter exit did not significantly affect outcomes. The study's limitations highlight the need for larger prospective studies to better understand and improve emergent PD management in this vulnerable population.
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Affiliation(s)
- Yi-Hsuan Huang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Chia-Man Chou
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
| | - Sheng-Yang Huang
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung City, Taiwan
| | - Hou-Chuan Chen
- Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
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Akbalık Kara M, Pınarbaşı AS, Çelik M. Peritoneal dialysis for term neonates in a neonatal intensive care unit. Pediatr Int 2022; 64:e15155. [PMID: 35616157 DOI: 10.1111/ped.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the indications, complications, and outcomes of peritoneal dialysis (PD) in term neonates from a state hospital. METHODS The demographic, clinical, and laboratory data of 67 newborn term infants who underwent PD within the first 4 weeks of life between June 2014 and June 2019 were retrospectively analyzed. RESULTS Twenty-five patients (37.3%) were male, 42 (63.7%) were female. The mean gestational age was 38.3 ± 0.8 (range: 37-40) weeks and mean birthweight 3,100 ± 504.9 g (range: 1,800-5,000 g). The mean age of patients at the start of dialysis was 7.97 ± 8.34 days (range:1-44 days) and the mean duration for dialysis was 3 ± 5.42 days (range 1-40 days). The majority of patients who underwent PD had inborn error of metabolism (59.7%). The most common complication was dialysate leakage. Thirty-three neonates (49.2%) died during PD process because of underlying disease, 17 patients (25.4%) were referred to other centers, and 17 patients (25.4%) were discharged. There were seven acute kidney injury patients associated with hypernatremic dehydration. There were statistically significant differences between non-survivors and survivors in terms of dialysis duration, birthweight, weight at admission, requirements for mechanical ventilation, and inotrop agent, and also the renal angina index. CONCLUSIONS In our region, hypernatremic dehydration is still a one of the major cause for acute kidney injury (AKI) in newborns. In state hospitals, pediatric specialists must be present in neonatal intensive care units in order not to refer unstable patients to other centers and to provide high-quality patient care.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Muhittin Çelik
- Department of Neonatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Batte A, Murphy KJ, Namazzi R, Co K, Opoka RO, Ssenkusu JM, John CC, Conroy AL. Evaluating kidney function using a point-of-care creatinine test in Ugandan children with severe malaria: a prospective cohort study. BMC Nephrol 2021; 22:369. [PMID: 34742257 PMCID: PMC8572470 DOI: 10.1186/s12882-021-02573-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Acute kidney injury (AKI) disproportionately affects individuals in low-and middle-income countries (LMIC). However, LMIC—particularly countries in sub-Saharan Africa— are under-represented in global AKI research. A critical barrier in diagnosing AKI is access to reliable serum creatinine results. We evaluated the utility of a point-of-care test to measure creatinine and diagnose AKI in Ugandan children with malaria. Methods Paired admission creatinine was assessed in 539 Ugandan children 6 months to 4 years of age hospitalized with severe malaria based on blood smear or rapid diagnostic test. Creatinine levels were measured using isotope dilution mass spectrometry (IDMS)-traceable methods. The reference creatinine was measured using the modified Jaffe method by a certified laboratory and the point-of-care testing was conducted using an i-STAT blood analyzer (i-STAT1, with and without adjustment for the partial pressure of carbon dioxide). AKI was defined and staged using the Kidney Disease: Improving Global Outcomes criteria. Results The mean age of children was 2.1 years, and 21.6% of children were stunted. Mortality was 7.6% in-hospital. Over the entire range of measured creatinine values (<0.20mg/dL-8.4mg/dL), the correlation between the reference creatinine and adjusted and unadjusted point-of-care creatinine was high with R2 values of 0.95 and 0.93 respectively; however, the correlation was significantly lower in children with creatinine values <1mg/dL (R2 of 0.44 between the reference and adjusted and unadjusted i-STAT creatinine). The prevalence of AKI was 45.5% using the reference creatinine, and 27.1 and 32.3% using the unadjusted and adjusted point-of-care creatinine values, respectively. There was a step-wise increase in mortality across AKI stages, and all methods were strongly associated with mortality (p<0.0001 for all). AKI defined using the reference creatinine measure was the most sensitive to predict mortality with a sensitivity of 85.4% compared to 70.7 and 63.4% with the adjusted and unadjusted point-of-care creatinine values, respectively. Conclusions Point-of-care assessment of creatinine in lean Ugandan children <4 years of age underestimated creatinine and AKI compared to the clinical reference. Additional studies are needed to evaluate other biomarkers of AKI in LMIC to ensure equitable access to AKI diagnostics globally.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kristin J Murphy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Ruth Namazzi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Katrina Co
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA
| | - Andrea L Conroy
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, 1044 W. Walnut St., Indianapolis, IN, 46202, USA.
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Tomar A, Kumar V, Saha A. Peritoneal dialysis in children with sepsis-associated AKI (SA-AKI): an experience in a low- to middle-income country. Paediatr Int Child Health 2021; 41:137-144. [PMID: 33455545 DOI: 10.1080/20469047.2021.1874201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.Aim: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.Methods: Early PD (n = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (n = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.Results: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (p < 0.001). The duration of PD was less if it was commenced early (p < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (p < 0.001).Conclusions: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.Abbreviations : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.
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Affiliation(s)
- Apurva Tomar
- Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Virendra Kumar
- Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
| | - Abhijeet Saha
- Department of Paediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India
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Igiraneza G, Dusabejambo V, Finklestein FO, Rastegar A. Challenges in the Recognition and Management of Acute Kidney Injury by Hospitals in Resource-Limited Settings. Kidney Int Rep 2020; 5:991-999. [PMID: 32647756 PMCID: PMC7336002 DOI: 10.1016/j.ekir.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 04/06/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction Acute kidney injury (AKI) is prevalent in low- and middle-income countries (LMIC) and is associated with significant morbidity and mortality, particularly among hospitalized patients. Successful strategies for the prevention and management of AKI in these countries are dependent on the capacity of primary care centers to provide optimal initial management of patients at risk for this disorder. Methods From December 2018 to February 2019, using mixed methods, we assessed hospital capacity and the knowledge of clinicians relevant to the prevention, diagnosis, and management of AKI in Rwanda. A checklist based on Kidney Disease: Improving Global Outcomes (KDIGO) guidelines and clinical vignette-based assessment tool were used to assess hospital capacity and provider knowledge base, respectively. Data were analyzed using stata 13 with findings reported as simple frequencies or means with standard deviation. Multivariate analysis was used to assess factors associated with a higher knowledge score among clinicians. Results Ten hospitals and 193 health care providers from sites throughout Rwanda participated in the survey. Surveyed hospitals were equipped with basic general medical equipment but were deficient in diagnostic tools and medical supplies that would allow the diagnosis and nondialytic management of AKI. Although 20% of the hospitals could offer hemodialysis services, peritoneal dialysis services were nonexistent. With regard to knowledge base, the health care providers demonstrated significant deficiencies in the diagnosis and management of AKI. The mean knowledge score for all health providers was 6.3 (±1.5) of a maximum of 11, with a mean (±SD) score for doctors, nurses, and midwives of 6.3 ± 2.05, 6.4 ± 1.3, and 6.08 ± 1.2, respectively. On multivariate analysis, the length of clinical experience and age of the respondents were significantly associated with participants’ knowledge score. Conclusion This study documents significant barriers to providing optimal management of AKI in primary health care settings in Rwanda, a resource-limited setting. These include lack of specialized medical personnel, significant knowledge gaps among primary health care providers, suboptimal diagnostic capacity, and limited treatment options for detection and management of AKI.
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Affiliation(s)
- Grace Igiraneza
- Department of Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
- Yale University School of Medicine, New Haven, Connecticut, USA
- Correspondence: Grace Igiraneza, Nephrology Unit, Department of Medicine, University Teaching Hospital of Kigali, P.O. BOX 655, Kigali, Rwanda.
| | - Vincent Dusabejambo
- Department of Medicine, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
| | - Fredric O. Finklestein
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Asghar Rastegar
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA
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Nkoy AB, Ndiyo YM, Matoka TT, Odio BM, Kazadi OK, Aloni MN, Collard L, McCulloch M, Ngiyulu RM, Gini JLE, Lepira FB, van den Heuvel LP, Levtchenko E, Ekulu PM. A promising pediatric peritoneal dialysis experience in a resource-limited setting with the support of saving young lives program. Perit Dial Int 2020; 40:504-508. [PMID: 32063192 DOI: 10.1177/0896860819887286] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.
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Affiliation(s)
- Agathe B Nkoy
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Yoli M Ndiyo
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Therance T Matoka
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Bienvenu M Odio
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Orly K Kazadi
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Michel N Aloni
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Laure Collard
- Division of Nephrology, Department of Pediatrics, Clinique de l'Espérance, CHC, Liège, Belgium
| | - Mignon McCulloch
- Division of Paediatric Nephrology, Department of Child and Adolescent Health, Red Cross War Memorial Children's Hospital, 37716University of Cape Town, South Africa
| | - Rene M Ngiyulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Jean-Lambert E Gini
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - François B Lepira
- Division of Nephrology, Department of Internal Medicine, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo
| | - Lambertus P van den Heuvel
- Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
| | - Elena Levtchenko
- Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
| | - Pepe M Ekulu
- Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo.,Department of Pediatric Nephrology, 26657KU Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Belgium
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Abstract
PURPOSE OF REVIEW To assess the use, access to and outcomes of hemodialysis and peritoneal dialysis in low-resource settings. RECENT FINDINGS Hemodialysis tends to predominate because of costs and logistics, however services tend to be located in larger cities, often paid for out of pocket. Outcomes of dialysis-requiring acute kidney injury and end-stage kidney disease may be similar with hemodialysis and peritoneal dialysis, and therefore choice of therapy is dominated by availability, accessibility and patient or physician choice. Some countries have implemented peritoneal dialysis-first policies to reduce costs and improve access, because peritoneal dialysis requires less infrastructure, can be scaled up more easily and can be cheaper when fluids are manufactured locally. SUMMARY Access to both hemodialysis and peritoneal dialysis remains highly inequitable in lower-resource settings. Although challenges associated with dialysis in low-resource settings are similar, and there are more adults who require dialysis in low-resource settings, addressing hemodialysis and peritoneal dialysis needs of children in low-resource settings requires attention as the global inequities are greatest in this area. Lower-income countries are increasingly seeking to improve access to dialysis through various strategies, but meeting the costs of the entire dialysis population continues to be a major challenge.
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Vasudevan A, Phadke K, Yap HK. Peritoneal dialysis for the management of pediatric patients with acute kidney injury. Pediatr Nephrol 2017; 32:1145-1156. [PMID: 27796620 DOI: 10.1007/s00467-016-3482-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
Renal replacement therapy (RRT) is the most important supportive measure used in the management of acute kidney injury (AKI). Peritoneal dialysis (PD) is a safe, simple and inexpensive procedure and has been used in pediatric AKI patients, ranging from neonates to adolescents. It is the modality of choice for RRT in developing countries with cost constraints and limited resources. However, its use has declined with the availability of newer types of extracorporeal modalities for RRT in the developed world. Much controversy exists regarding the dosing and adequacy of PD in the management of AKI. Data in infants and children have shown that PD can provide adequate clearance, ultrafiltration and correction of metabolic abnormalities even in those who are critically ill. Although there are no prospective studies in children, data from retrospective studies reveal no differences in mortality rates between different modalities of RRT. In this review, we discuss the advantages and limitations of PD, indications for acute PD, strategies to improve the efficiency of acute PD and outcomes of PD in children with AKI.
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Affiliation(s)
- Anil Vasudevan
- Department of Pediatric Nephrology, St. John's Medical College Hospital, Bengaluru, Karnataka, India, 560034.
| | | | - Hui-Kim Yap
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore, Singapore
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