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Dialysis for paediatric acute kidney injury in Cape Town, South Africa.
- Source :
-
Pediatric nephrology (Berlin, Germany) [Pediatr Nephrol] 2024 Sep; Vol. 39 (9), pp. 2807-2818. Date of Electronic Publication: 2024 May 11. - Publication Year :
- 2024
-
Abstract
- Background: Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings.<br />Methods: Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020.<br />Results: Of the 593 children with AKI who received dialysis, 463 (78.1%) received PD first. Median age was 9.0 (range 0.03-219.3; IQR 13.0-69.6) months; 57.6% were < 1 year old. Weights ranged from 0.9 to 2.0 kg (median 7.0 kg, IQR 3.0-16.0 kg); 38.6% were < 5 kg. PD was used more in younger children compared to extracorporeal dialysis (ECD), with median ages 6.4 (IQR 0.9-30.4) vs. 73.9 (IQR 17.5-113.9) months, respectively (p = 0.001). PD was performed with Seldinger soft catheters (n = 480/578, 83%), predominantly inserted by paediatricians at the bedside (n = 412/490, 84.1%). Complications occurred in 127/560 (22.7%) children receiving PD. Overall, 314/542 (57.8%) children survived. Survival was significantly lower in neonates (< 1 month old, 47.5%) and infants (1-12 months old, 49.2%) compared with older children (> 1 year old, 70.4%, p < 0.0001). Survival was superior in the ECD (75.4%) than in the PD group (55.6%, p = 0.002).<br />Conclusions: "PD First for Paediatric AKI" is a valuable therapeutic approach for children with AKI. It is feasible in low-resourced settings where bedside PD catheter insertion can be safely taught and is an acceptable dialysis modality, especially in settings where children with AKI would otherwise not survive.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
South Africa epidemiology
Retrospective Studies
Child, Preschool
Male
Infant
Female
Child
Adolescent
Renal Dialysis adverse effects
Renal Dialysis methods
Infant, Newborn
Treatment Outcome
Acute Kidney Injury therapy
Acute Kidney Injury mortality
Acute Kidney Injury epidemiology
Peritoneal Dialysis adverse effects
Peritoneal Dialysis methods
Subjects
Details
- Language :
- English
- ISSN :
- 1432-198X
- Volume :
- 39
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Pediatric nephrology (Berlin, Germany)
- Publication Type :
- Academic Journal
- Accession number :
- 38733539
- Full Text :
- https://doi.org/10.1007/s00467-024-06399-1