Management of acute renal failure in infants: a seven-year multicenter experience.

Abstract

Background. An infant with acute kidney injury (AKI) represents a technical challenge with respect to vascular access. Acute peritoneal dialysis (PD) is often the only possible treatment modality. Patients and methods. Over a period of 7 years (2014 -2021), the outcome of acute PD was studied in 56 infants (38 boys) with AKI, aged 6 hours to 24 months, at 3 tertiary care centers of a teaching hospital in Algeria. Results. Acute tubular necrosis (58.9%) was the most common cause of AKI, followed by hemolytic uremic syndrome (23.2 %). Acute PD was highly effective in lowering retention markers (p < 0.0001). The reduction of blood urea greater than 11% after 10 cycles of PD would be the first sign of good evolution followed by that of serum creatinine at 10% after 15 cycles (p < 0.0001). Hypokaliemia was the most common complication (46.4%). Overall mortality was 23.2 %. The risk of mortality by multi-variate analysis was higher with the Severity of AKI and when patients were anuric (p < 0.0001), septicemia (p < 0.0001), or decompensated congenital heart disease (p < 0.001) The survivors did not differ from those who died with respect to age, sex or weight when acute PD was initiated. The average time to renal function recovery was between 72 hours and 12 days. Conclusion. Acute PD is an appropriate treatment choice for infants with AKI. The reduction of blood urea after 10 cycles of PD is a good predictor of evolution.