Diálisis peritoneal crónica pediátrica en Chile: Estudio multicéntrico

Abstract

Peritoneal dialysis (PD) is the most important renal replacement therapy in children with chronic renal failure. Our aim was to assess the status of children from 4 public hospitals on PD after a programme in 1995 was started. Patients and Methods : 129 children younger than 18 were evaluated, 97 of whom had at least 6 months of follow up. Epidemiological and demographic data, metabolic parameters, growth and dialysis adequacy were recorded. Statistical analysis was carried out using Excel 5.0, Stata for Windows 6.0 and Epi Info 6.0. Multiple regression analysis was used to establish correlations between independent and dependent variables and Chi squared for comparison of proportions. Correlation analysis was performed to study 2 continuous variables simultaneously using the quotient of Pearson correlation and Kaplan-Meier curves for dropout probability on PD. Results : mean age 8.6 ± 4.7 yrs (range 0.16-16.9), 51% female. Aetiologies, hypo/displasia 26%, glomerulopathies 17%, reflux nephropathy 15%, obstructive uropathy 14%. Moderate to severe anemia was found in 65%. Serum calcium increased from 8.9 mg/dl to 9.3 mg/dl after PD (p < 0.05). Parathyroid hormone and alkaline phosphatase correlated significantly (p < 0.0004). Mean score Z height/age was -2.2 ± 1.6. A progressive but not significant impairment score Z height/age was found, growth failure was less in children who started PD at a younger age. The overall frequency of peritonitis was 0.67 episodes/patient/year. Staphylococcus aureus accounted for the majority of episodes. Mean creatinine clearence was 14 ± 7.2 ml/min. The mean weekly urea Kt/V was 2.9 ± 1.9, children under 5 showed a significantly higher Kt/V (p < 0.05). High peritoneal transport capacity was maintained during the follow-up. Peritoneal ultrafiltration capacity progressively decreased after 6 months (p < 0.05). Conclusions : The incidence of DPCA has increased progressively in our country in the last 5 years, with an increase in the number of younger patients starting PD. Hematological and biochemical parameters improved with PD. Poor growth rates were related to longer time-averaged dialysis. Dialysis doses were inversely related to age. High transporter capacity was maintained during follow-up. Staphylococcus aureus accounted for the majority of peritonitis episodes, peritonitis incidence being similar to that reported in the literature. In order to obtain reliable results that improve the quality of life it is necessary to establish a common programme of dialysis adequacy.