Abstract
HypothesisAcute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability.MethodsA 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests.ResultsPD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants.ConclusionsLack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world.
Highlights
Acute Kidney Injury (AKI) is common and imposes a heavy burden of morbidity and mortality
peritoneal dialysis (PD) was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), Continuous renal replacement therapy (CRRT) was available in 60% and 33.3% (p = 0.001), and sustained low efficiency dialysis (SLED) was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively
68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants
Summary
Acute Kidney Injury (AKI) is common and imposes a heavy burden of morbidity and mortality. Continuous renal replacement therapy (CRRT) is the mainstay treatment for severe pediatric AKI, but expense and complexity reduces accessibility; in a developing nation, one must often choose between available treatment and standard of care [5]. Three survey studies examining RRT modalities in pediatric patients compared three modes of pediatric dialysis: peritoneal dialysis (PD), hemodialysis (HD), and CRRT. These studies examined physician choice in RRT mode in North America, Europe and India [6,7,8], there is a need for updated literature. The purpose of this study was to conduct a survey to assess the trend of physician choice in mode of RRT use for AKI in children globally. We hope to provide more evidence surrounding global health in regards to RRT in pediatric populations, lending a modern perspective into the disparities and unique challenges developing countries face
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