Outcome of Peritoneal Dialysis in Children with Acute Kidney Injury

Abstract

Objective: To analyze the outcomes of PD in AKI cases among the pediatric population at a public sector tertiary care institute in Karachi, Pakistan.

Study Design: Longitudinal study

Place and Duration of Study: This study was conducted at the National Institute of Child Health, Karachi from May 2021 to March 2022.

Materials and Methods: Acute kidney injury was considered when creatinine clearance was decreased by 50% based on the modified pediatric RIFLE. During the study period, patients were observed for the development of catheter-related complications and mortality.

Results: A total of 160 patients with AKI underwent PD during the study. The mean age of patients was 14 (7 - 48) months and the majority of the patients were males (56.3%) at baseline mean serum creatinine, phosphate, calcium and sodium levels were 5.2 ± 0.23 mg/dL, 5.7 ± 1.9 mg/dL, 7.5±1.8mg/dL and 130±18.5 respectively. The most frequent cause of AKI was sepsis (26.9%). During the hospital stay, 97(60.6%) patients developed complications. The most frequent complication was peritonitis (23.8%) followed by catheter displacement (13.1%), catheter obstruction (10%), bleeding (8.1%), catheter leakage (4.4%), and exit site cellulitis (1.3%). In-hospital mortality was seen in 68(42.5%) patients. Frequency of PCKD (p=0.020), shock sign (p<0.001), febrile patients (p=0.021), sepsis (p=0.002), development of complications (p=0.004), peritonitis (p<0.001) and inotrope support (p<0.001) was significantly different among survivors and non-survivors. Serum creatinine (p=0.021) and phosphate (p=0.016) were significantly raised among non-survivors.

Conclusion: The present study demonstrated that the modality of peritoneal dialysis can be adopted in resource-limited settings. However, a multidisciplinary care model should be adopted for the prevention of complications associated with peritoneal dialysis catheters.