MON-076 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS (CAPD) IN CHILDREN: A SUCCESSFUL CASE FOR A BRIGHT FUTURE IN A DEVELOPING COUNTRY

Abstract

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 particularly for children . PD remains a reliable alternative for renal replacement in pediatrics acute and chronic situations. The authors report the first case of successful CAPD in pediatrics in a 13-year-old Senegalese, resident 121 Km from Dakar. This was a 13-year-old boy monitored in the unit since 2017-10-04 for stage V Chronic Kidney Disease (CKD) following a primary nephrotic syndrome by Segmental and Focal Glomerulosclerosis (FSGS) cortico-resistant and cyclo-resistant since he was 11 years old. The patient was anuric. Faced with signs of intolerance in uremia, he first received two successive sessions of haemodialysis then 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. The TENCKOFF catheter was inserted on 2018-03-05 in urology in collaboration with the pediatrics and adult nephrology team. On day 1 after catheter insertion, the peritoneal cavity was rinsed. On day 2 after insertion, the patient had a fever at 39oC, abdominal pain and greenish vomiting. Upon examination, he would scream when his navel is touched. Analysis of the drainage liquid had revealed 650 leucocytes/mm3 with 62% of neutrophils. The dialysate culture was sterile. The hemoculture came back negative. The nasal swab isolated Staphylococcus aureus. The patient received 1g of C3G in each bag of 2L of dialysate associated with a bacitracin+neomycine nasal rub as from day 2 after catheter insertion. The plan proposed to the patient was 4 swabs a day (8am - 12noon - 4pm - 8pm - 8am) with a stasis of isotonic dialysate of 4 hours per session during the day and a stasis of icodextrin for 8 hours at night. The volume of injection per cycle was 1L of dialysate. The peritoneal control fluid at day 7 was sterile. The antibiotic treatment was done by oral route for 14 days. Besides the PD, the patient was receiving anti-hypertensive treatment, vitamin D supplementation, erythropoietin and a CKD diet. After the infection period, 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. 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. The patient and his mother returned home at Bambey, a town situated 121 Km from Dakar with a tracking sheet n which the weight, blood pressure, temperature and ultra filtrate are noted. After a second month of observation, the patient complained of abdominal pain at the day hospital. The plain abdominal X-ray revealed a catheter migration to the right. The catheter was repositioned in the patient through the use of laxatives. After 4 months of observation, the dialysis was considered adequate on a clinical and biological basis. 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.