Abstract
The authors report the first case of successful peritoneal dialysis (PD) in a developing country performed about a 13-year-old adolescent followed-up for stage V chronic kidney disease (CKD) with anuria. After 3 months of hemodialysis, the parents opted for continuous ambulatory peritoneal dialysis (CAPD) as they wished to return home located 121km from Dakar. After PD catheter insertion, the plan proposed to the patient consisted 3-4 hours stasis of isotonic dialysate during the day and a night stasis of 8 hours of icodextrin for an injection volume of 1L per session. The patient and his mother were trained and assessed on the PD technique. After dialysis adequacy was tested while hospitalised, they were able to return home and continued the sessions following the same plan prescribed and while keeping in touch, by telephone, with the medical team. The technique assessment at the day hospital every 2 weeks revealed dialysis adequacy and satisfactory tolerance of PD at home after 04 months of observation. It was the first case of successful CAPD in the pediatrics unit in this context. Scaling this technique is a challenge for the pediatric nephrologist in developing countries like Senegal.
Highlights
Management of chronic kidney disease remains a challenge in developing countries due to the absence of kidney transplant, limited access to extra-renal purification and the low involvement of health policies for children [1, 2]
The two PD modalities are represented by continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) with their variants [3,4,5]
Even though kidney transplant is the preferred treatment method for patients suffering from Chronic Kidney Disease (CKD), most patients are placed on dialysis while waiting for transplant or as the only treatment [3]
Summary
Management of chronic kidney disease remains a challenge in developing countries due to the absence of kidney transplant, limited access to extra-renal purification and the low involvement of health policies for children [1, 2]. Faced with signs of intolerance in uremia, he first received two successive sessions of haemodialysis three sessions per week for over 3 months in an adult center He was switched to CAPD following his parents' choice motivated by a desire to return home situated 121km from Dakar. An equilibration Test (PET test) revealed a Hyper-permeable peritoneal membrane with D/P creatinine at 0.91 The patient and his mother were trained and assessed on the PD technique (Figure 2 C). By the end of a month, they had become independent and could recognize the signs or dysfunction of the catheter Patient assessment during this first month of dialysis revealed an adequate clinical and biological condition (Table 1). After 4 months of observation, the dialysis was considered adequate on a clinical and biological basis (Table 1)
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