POS-630 DROP-OUT OF CHILDREN WITH ESKD FROM CHRONIC PERITONEAL DIALYSIS AND ASSOCIATED FACTORS, A TEN YEAR REVIEW AT RED CROSS WAR MEMORIAL CHILDREN’S HOSPITAL, SOUTH AFRICA

Abstract

Dialysis is a temporary kidney replacement therapy to keep children who develop end stage kidney disease (ESKD) healthy and alive while work up for kidney transplant, the preferred treatment, proceeds. Kidney transplantation may be preemptive. Chronic peritoneal dialysis (PD) is the preferred modality over hemodialysis (HD) in children because of the convenience of dialysis being performed at home as opposed to hospital visits for HD, avoids problems associated with vascular access and children face fewer school interruptions. Children may drop-out from PD due to complications and permanently switch to HD or die before being transplanted. We sought to investigate the rate of drop-out among children on chronic PD and describe some contributing factors. This was a retrospective descriptive study involving children entered onto the kidney transplant waiting list from 2009 to 2018. We recruited children who were on chronic PD over the 10 year study period. Drop-out was defined as permanent switch to HD or death while on PD. Relevant data was extracted from patient folders following ethical approval. Outcome measures were proportion of children dropping-out, factors associated with drop-out and timing of drop-out. A total of 111 children were listed for transplantation between January 2009 and December 2018, 67 were treated with PD (of whom 18 had previously been treated with HD) and 11 were treated with HD alone. Thirty three (33) children were not on any dialysis modality and either received preemptive kidney transplantation or remained on the waiting list at the end of the study period. Complete data was available for 52 of the 67 children who received PD. There were 25 (48%) females. The median age of all participants was 11 (interquartile range 6.0, 13.1) years. Forty seven (90%) children were cared for by parents. Chronic PD catheters were inserted laparoscopically in 90% of the children. The most frequent causes of ESKD were steroid resistant nephrotic syndrome (13%) and posterior urethral valves (12%) (Figure 1).The peritonitis rate was 1.2 episodes per patient year. Twenty two (42.3%) children had no episodes of peritonitis. The median duration of PD overall was 9 (range 1-60) months. The median duration of PD until transplantation was 11 months (interquartile range 6, 24.5), compared with 4 months (interquartile range 2, 14) among those who dropped-out of PD. At the end of the study period, 17/52 children (32.7%) dropped-out of PD before transplantation, with 13 (25%) switches to HD and 4 (7.6 %) deaths, while 29 were transplanted and 6 still on PD (35/52). One or more episodes of bacterial peritonitis was significantly associated with drop-out from PD (p = 0.017) (Table 1). Three deaths were directly related to PD complications and one was a result of pancytopenia. Switch to HD was mostly due to peritonitis complications. Over half of the children dropped-out within the first 12 months of PD (Table 2). Table 1. Factors associated with drop-out from PDView Large Image Figure ViewerDownload Hi-res image Download (PPT)Table 2: Description of the cases that dropped-out from PD and the timing of drop-out.View Large Image Figure ViewerDownload Hi-res image Download (PPT) We observed a high drop-out rate of 32.7% from chronic PD among children awaiting kidney transplantation at RCWMCH. There is a need to improve measures to prevent peritonitis to improve retention rates on chronic PD. Further prospective studies are required to better monitor peritonitis rates.