Pediatric Dialysis Research Articles

Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities.

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.

Clinical practice recommendations for native vitamin D therapy in children with chronic kidney disease Stages 2-5 and on dialysis.

Vitamin D deficiency is widely prevalent and often severe in children and adults with chronic kidney disease (CKD). Although native vitamin D {25-hydroxyvitamin D [25(OH)D]} is thought to have pleiotropic effects on many organ systems, its skeletal effects have been most widely studied. The 25(OH)D deficiency is causally linked with rickets and fractures in healthy children and those with CKD, contributing to the CKD-mineral and bone disorder (MBD) complex. There are few studies to provide evidence for vitamin D therapy or guidelines for its use in CKD. A core working group (WG) of the European Society for Paediatric Nephrology (ESPN) CKD-MBD and Dialysis WGs have developed recommendations for the evaluation, treatment and prevention of vitamin D deficiency in children with CKD. We present clinical practice recommendations for the use of ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3) in children with CKD Stages 2-5 and on dialysis. A parallel document addresses treatment recommendations for active vitamin D analogue therapy. The WG has performed an extensive literature review to include meta-analyses and randomized controlled trials in healthy children as well as children and adults with CKD, and prospective observational studies in children with CKD. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system has been used to develop and grade the recommendations. In the absence of applicable study data, the opinion of experts from the ESPN CKD-MBD and Dialysis WGs is provided, but clearly GRADE-ed as such and must be carefully considered by the treating physician, and adapted to individual patient needs as appropriate.

Rapport sur la dialyse chronique en France en 2016

The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers. Proposals are also made to stimulate peritoneal dialysis offers, (3) to improve the calculation of the cost of dialysis and warn against lower reimbursement rates of dialysis, (4) to reduce transport costs by minimizing transport by ambulance (5). The SFNDT recalls recent recommendations concerning access to the renal transplant waiting list, are recalled; (6) as well as recommendations that require waiting until clinical signs are present to start dialysis (7). The SFNDT makes the proposal to set up advanced renal failure units. These units are expected to develop care that is not supported today: consultation with a nurse, a dietician, a social worker or psychologist, palliative care, and coordination (8). Finally, the financial and human resources for pediatric dialysis should be maintained.

Hypoparathyroidism versus hyperparathyroidism in pediatric dialysis patients; a single center study

Background: Abnormalities in calcium, phosphorous and parathyroid hormone (PTH) metabolisms are common in dialysis patients. Reaching target levels for these serologic factors and calcium × phosphorous products is recommended to minimize cardiovascular events. years), gender and modality of dialysis.

Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Infections in Pediatric Dialysis Patients in Mubarak Al-Kabeer Hospital, Kuwait: 10 Year’s Experience

Infections in Pediatric Dialysis Patients in Mubarak Al-Kabeer Hospital, Kuwait: 10 Year’s Experience

Long-term outcomes in children with chronic kidney disease stage 5 over the last 40 years.

IntroductionWe evaluated outcomes in children with chronic kidney disease stage 5 (CKD 5) treated in the first pediatric dialysis unit in Poland during 1973-2012.Material and methodsThe retrospective analysis included 208 children with CKD 5 undergoing renal replacement therapy (RRT), stratified into four decades of treatment: 1973–1982, 1983–1992, 1993–2002, and 2003–2012.ResultsThe most common causes of CKD 5 included glomerulonephritis in 27.4% and pyelonephritis secondary to urinary tract anomalies in 25.5% of children. Among 208 children, 172 (82.7%) survived and 17.3% died. Kidney transplantation (KTx) was performed in 47.6% of children, including pre-emptive KTx in 1.92% of children. Chronic dialysis was continued in 34.1% of children, and RRT was withdrawn in 1%. The overall mortality rate was 6.2 per 100 patient-years, and 3-year survival was 83.9%. The highest mortality rate of 23.4 per 100 patient-years was observed among children in whom RRT was initiated in 1973–1982, with subsequent reduction of the mortality rate to 4.5 and 2.1 per 100 patient-years in 1993–2002 and 1983–1992 respectively. No deaths were noted after 2002. Cardiovascular problems were the most common cause of death, found in 36.1% of patients (p < 0.01). Identified risk factors for mortality included young age, low residual diuresis, anemia at the time of RRT initiation, and hypertriglyceridemia and hypoalbuminemia during RRT.ConclusionsIn years 1973–2012 significant improvement in prognosis among children with CKD 5 was achieved. Identified predictors of mortality included young age at initiation of RRT, low residual diuresis, anemia and hypertriglyceridemia.

Dialysis in Children and Adolescents: The Pediatric Nephrology Perspective

The care of children with end-stage renal disease (ESRD) is highly specialized and often poorly understood by nonpediatric providers and facility/institution administrators. As such, this position paper has been created to offer provider, facility, and institutional guidance regarding the components of care necessary for children receiving dialysis. Key differences between adult and pediatric dialysis units are highlighted. Responsibilities and expectations of the members of the interdisciplinary dialysis team are outlined as they pertain specifically to the care of pediatric dialysis patients. Physical and staffing requirements of the dialysis facility are reviewed, again focusing on unique needs and challenges faced by the pediatric dialysis care team. Among these, vascular access options and proper planning of ESRD care are underscored. Pediatric quality-of-life metrics differ significantly from adult quality variables, and proper tools for assessment must be used. Endorsed by the Council of the American Society of Pediatric Nephrology (ASPN), this position paper serves as a reference tool for the provision of care to pediatric patients with ESRD.

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes.

Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Data were derived from 824 incident and 1629 prevalent patients from 105 pediatric nephrology centers enrolled in the International Pediatric Peritoneal Dialysis Network Registry between 2007 and 2015. In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of follow-up, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 months, respectively. By multivariate logistic regression analysis, risk of access revision was associated with younger age (odds ratio, 0.93; 95% confidence interval, 0.92 to 0.95; P<0.001), diagnosis of congenital anomalies of the kidney and urinary tract (odds ratio, 1.28; 95% confidence interval, 1.03 to 1.59; P=0.02), coexisting ostomies (odds ratio, 1.42; 95% confidence interval, 1.07 to 1.87; P=0.01), presence of swan neck tunnel with curled intraperitoneal portion (odds ratio, 1.30; 95% confidence interval, 1.04 to 1.63; P=0.02), and high gross national income (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19; P=0.01). Main reasons for access revisions included mechanical malfunction (60%), peritonitis (16%), exit site infection (12%), and leakage (6%). Need for access revision increased the risk of peritoneal dialysis technique failure or death (hazard ratio, 1.35; 95% confidence interval, 1.10 to 1.65; P=0.003). Access dysfunction due to mechanical causes doubled the risk of technique failure compared with infectious causes (hazard ratio, 1.95; 95% confidence interval, 1.20 to 2.30; P=0.03). Peritoneal dialysis catheter revisions are common in pediatric patients on peritoneal dialysis and complicate provision of chronic peritoneal dialysis. Attention to potentially modifiable risk factors by pediatric nephrologists and pediatric surgeons should be encouraged.

Racial-ethnic disparities in mortality and kidney transplant outcomes among pediatric dialysis patients.

Previous studies in adult hemodialysis patients have shown that African-American and Hispanic patients have a lower risk of mortality in addition to a lower likelihood of kidney transplantation. However, studies of the association between race and outcomes in pediatric dialysis are sparse and often do not examine outcomes in Hispanic children. The objective was to determine if racial-ethnic disparities in mortality and kidney transplantation outcomes exist in pediatric dialysis patients. This was a retrospective cohort analysis of 2,697 pediatric dialysis patients (aged 0-20 years) from a large national dialysis organization (entry period 2001-2011) of non-Hispanic white, African-American, and Hispanic race-ethnicity. Associations between race-ethnicity with mortality and kidney transplantation outcomes were examined separately using competing risks methods. Logistic regression analyses were used to examine the association between race-ethnicity, with outcomes within 1year of dialysis initiation. Of the 2,697 pediatric patients in this cohort, 895 were African-American, 778 were Hispanic, and 1,024 were non-Hispanic white. After adjusting for baseline demographics, competing risk survival analysis revealed that compared with non-Hispanic whites, African-Americans had a 64% higher mortality risk (hazards ratio [HR] = 1.64; 95% CI 1.24-2.17), whereas Hispanics had a 31% lower mortality risk (HR = 0.69; 95% CI 0.47-1.01) that did not reach statistical significance. African-Americans also had higher odds of 1-year mortality after starting dialysis (odds ratio [OR] = 2.08; 95% CI 0.95-4.58), whereas both African-Americans and Hispanics had a lower odds of receiving a transplant within 1year of starting dialysis (OR = 0.28; 95% CI 0.19-0.41 and OR = 0.43; 95% CI 0.31-0.59 respectively). In contrast to adults, African-American pediatric dialysis patients have worse survival than their non-Hispanic white counterparts, whereas Hispanics have a similar to lower mortality risk. Both African-American and Hispanic pediatric dialysis patients had a lower likelihood of kidney transplantation than non-Hispanic whites, similar to observations in the adult dialysis population.

A contemporary approach to the prevention of peritoneal dialysis-related peritonitis in children: the role of improvement science.

Peritonitis is a leading cause of hospitalizations, morbidity, and modality change in pediatric chronic peritoneal dialysis (CPD) patients. Despite guidelines published by the International Society for Peritoneal Dialysis aimed at reducing the risk of peritonitis, registry data have revealed significant variability in peritonitis rates among centers caring for children on CPD, which suggests variability in practice. Improvement science methods have been used to reduce a variety of healthcare-associated infections and are also being applied successfully to decrease rates of peritonitis in children. A successful quality improvement program with the goal of decreasing peritonitis will not only include primary drivers directly linked to the outcome of peritonitis, but will also direct attention to secondary drivers that are important for the achievement of primary drivers, such as health literacy and patient and family engagement strategies. In this review, we describe a comprehensive improvement science model for the reduction of peritonitis in pediatric patients on CPD.

Serum albumin and von Willebrand factor: possible markers for early detection of vascular damage in children undergoing peritoneal dialysis.

Cardiovascular diseases are the main causes of morbidity and mortality in children with end-stage renal disease and the relationships among several relevant potential biomarkers were investigated in pediatric peritoneal dialysis patients. Serum homocysteine, von Willebrand factor (vWF), apolipoproteins A and B, lipoprotein-a, high sensitive-CRP, hemoglobin, phosphorus and parathyroid hormone (PTH) levels, systolic (SBP) and diastolic (DBP) blood pressure, carotid intima-media thickness (cIMT) and left ventricular mass index (LVMI) were measured in 21 pediatric peritoneal dialysis patients and control subjects. All risk factors were higher in patients than controls. LVMI values were negatively correlated with hemoglobin and positively correlated with PTH and phosphorus levels (p=0.007, r= - 0.573; p=0.013, r= 0.532 and p=0.035, r= 0.461, respectively). cIMT was negatively associated with serum albumin and positively correlated with vWF levels and with SBP and DBP (p=0.006, r= - 0.578; p=0.039, r= 0.453; p=0.02, r= 0.503; p=0.024, r= 0.491, respectively). Robust regression analyses showed that hemoglobin was an independent predictor of LVMI and serum albumin was an independent predictor of cIMT. Only uremia-related factors were independent risk factors for predicting LVMI and cIMT. Hemoglobin level may be a critical factor in the development of left ventricular hypertrophy; therefore, effective treatment of anemia is crucial. Low serum albumin and high hsCRP and vWF levels, and their correlations with cIMT, indicate these patients could be at risk of developing malnutrition-inflammation-atherosclerosis syndrome and suggest that serum albumin and vWF levels may be useful markers for early detection of vascular damage.

Quality of Life among Children Suffering from Chronic Kidney Disease

Aim of the study: was to assess the quality of life among children suffering from chronic kidney disease. Research design: A descriptive design was used in this study. Setting: This study was conducted in the pediatric nephrology clinic, and the pediatric conservative nephrology clinic of the pediatric dialysis unit at Ain Shams University Children Hospital. Sampling: A Purposive sample, 164 children with their mothers. The criteria of sample: - the inclusion criteria included all available children with age 4-12 years old, both gender and their mothers. Tools of data collection: The first tool:- A questionnaire tool included the following Socio-demographic data of children, Socio-demographic data of mothers and fathers, environmental assessment for children living in. Assessment of mother's knowledge about CKD, and assessment of mother's practice related to children health needs and problem related to CKD by mother's role towards the needs and problem. The second tool: - Quality of life inventory scale was constructed to assess level of quality of life for children with chronic kidney disease. The third tool: Children medical record to assess health status of children. Results: As regards characteristics of the studied children it was found that 41.5% of the studied children were in age from 4<6 year, and 59.8% of the studied children were males, and that 68.9% of the studied sample had a positive level of physical domain of quality of life, that there was a highly statistical significant relation (p<0.001) between total knowledge and total QOL. Conclusion: - In conclusion the finding of this study revealed that 41.5% of the studied t of children age was ranged from 4<6years, Indeed less than half of mothers had unsatisfactory total knowledge, and uncorrected total practice. Most of the children were low weight, and the majority were suffering from loss of appetite. There was statistical significant relation between mothers' age, educational level, and their total practice. Represent that there was a highly statistical significant relation (P<0.001) between total knowledge and total QOL. And clarifies that was highly statistical significant relation between total knowledge and total practice. Recommendations: Educational training programs to children with CKD and their mother to update their knowledge and practice. Effort should be made to reduce the CKD complications among children through adopting a national strategies and plans of CKD prevention, care and control.

APPLICATION RENAL REPLACEMENT THERAPY IN CHILDREN IN KEMEROVO REGION

The paper features comparative outcomes of applying different methods of renal replacement therapy for acute renal failure and chronic renal failure in children at the pediatric dialysis unit of the Russian children’s hospital «Zonal perinatal centre» in Novokuznetsk. The use of renal replacement therapy as an optimal method for achieving adequate and effective replacement of kidney function is validated. There are treated 58 children, 37 patients with acute kidney injury and 21 with terminal chronic renal failure. Acute renal failure was prevailed in preschoolers of 1–6 years old children – 24 (64,8 %), the terminal chronic renal failure in school children and teenagers – 16 (76,2 %). The renal replacement therapy used in 5 (13,5 %) patients with septic diseases, and in 6 (16,2 %) patients with poisons diseases. Methods of renal replacement therapy is effectively cleansing of the blood in critically ill patients. This method can reduce the rate of mortality and effectively adjust homeostasis in severe infections, septic diseases, multiple organ dysfunction syndrome and in patients with poisons diseases. Application of peritoneal dialysis allows as effective replacement of renal function in the children with difficulty vascular access.

Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis

The Standardizing Care to improve Outcomes in Pediatric End stage renal disease (SCOPE) Collaborative aims to reduce peritonitis rates in pediatric chronic peritoneal dialysis patients by increasing implementation of standardized care practices. To assess this, monthly care bundle compliance and annualized monthly peritonitis rates were evaluated from 24 SCOPE centers that were participating at collaborative launch and that provided peritonitis rates for the 13 months prior to launch. Changes in bundle compliance were assessed using either a logistic regression model or a generalized linear mixed model. Changes in average annualized peritonitis rates over time were illustrated using the latter model. In the first 36 months of the collaborative, 644 patients with 7977 follow-up encounters were included. The likelihood of compliance with follow-up care practices increased significantly (odds ratio 1.15, 95% confidence interval 1.10, 1.19). Mean monthly peritonitis rates significantly decreased from 0.63 episodes per patient year (95% confidence interval 0.43, 0.92) prelaunch to 0.42 (95% confidence interval 0.31, 0.57) at 36 months postlaunch. A sensitivity analysis confirmed that as mean follow-up compliance increased, peritonitis rates decreased, reaching statistical significance at 80% at which point the prelaunch rate was 42% higher than the rate in the months following achievement of 80% compliance. In its first 3 years, the SCOPE Collaborative has increased the implementation of standardized follow-up care and demonstrated a significant reduction in average monthly peritonitis rates.

Mortality risk in European children with end-stage renal disease on dialysis

We aimed to describe survival in European pediatric dialysis patients and compare the differential mortality riskbetween patients starting on hemodialysis (HD) and peritoneal dialysis (PD). Data for 6473 patients under 19years of age or younger were extracted from the European Society of Pediatric Nephrology, the European Renal Association, and European Dialysis and Transplant Association Registry for 36 countries for the years 2000 through 2013. Hazard ratios (HRs) were adjusted for age at start of dialysis, sex, primary renal disease, and country. A secondary analysis was performed on a propensity score-matched (PSM) cohort. The overall 5-year survival rate in European children starting on dialysis was 89.5% (95% confidence interval [CI] 87.7%-91.0%). The mortality rate was 28.0 deaths per 1000 patient years overall. This was highest (36.0/1000) during the first year of dialysis and in the 0- to 5-year age group (49.4/1000). Cardiovascular events (18.3%) and infections (17.0%) were the main causes of death. Children selected to start on HD had an increased mortality risk compared with those on PD (adjusted HR 1.39, 95% CI 1.06-1.82, PSM HR 1.46, 95% CI 1.06-2.00), especially during the first year of dialysis (HD/PD adjusted HR 1.70, 95% CI 1.22-2.38, PSM HR 1.79, 95% CI 1.20-2.66), when starting at older than 5 years of age (HD/PD: adjusted HR 1.58, 95% CI 1.03-2.43, PSM HR 1.87, 95% CI 1.17-2.98) and when children have been seen by a nephrologist for only a short time before starting dialysis (HD/PD adjusted HR 6.55, 95% CI 2.35-18.28, PSM HR 2.93, 95% CI 1.04-8.23). Because unmeasured case-mix differences and selection bias may explain the higher mortality risk in the HD population, these results should be interpreted with caution.

Update on Ethical Issues in Pediatric Dialysis: Has Pediatric Dialysis Become Morally Obligatory?

Improvements in pediatric dialysis over the past 50 years have made the decision to proceed with dialysis straightforward for the majority of pediatric patients. For certain groups, however, such as children with multiple comorbid conditions, children and families with few social and economic resources, and neonates and infants, the decision of whether to proceed with dialysis remains much more controversial. In this review, we will examine the best available data regarding the outcomes of dialysis in these populations and analyze the important ethical considerations that should guide decisions regarding dialysis for these patients. We conclude that providers must continue to follow a nuanced and individualized approach in decision making for each child and to recognize that, regardless of the decision reached about dialysis, there is a continued duty to care for patients and families to maximize the remaining quality of their lives.

Psychosocial Factors That Create Barriers to Managing Serum Phosphorus Levels in Pediatric Dialysis Patients: A Retrospective Analysis

Abnormal phosphorus homeostasis is among the medley of metabolic disturbances commonly associated with chronic kidney disease. We sought to determine the psychosocial factors that create barriers to controlling serum phosphorus levels in children on dialysis and to evaluate the perceptions of children and caregivers on the ease or difficulty of following a dietary phosphorus restriction and taking phosphorus binder medications. Single center cross-sectional study. Pediatric dialysis unit at a children's hospital. Forty-eight patients on chronic hemodialysis or peritoneal dialysis (mean age: 11.03±6.88years; 69% male). Serum phosphorus levels were recorded from electronic health records and converted to a mean phosphorus standard deviation score (SDS) for each individual. Mean phosphorus SDS values were compared to each independent categorical variable using an analysis of variance test, continuous variables were analyzed using linear regression, and logistic regression was used to determine odds ratios. There was a significant relationship between age and phosphorus SDS (P<.001), with patients over 13years of age having the highest prevalence of hyperphosphatemia (88%). Patients and caregivers who identified phosphorus levels as "controlled" had lower phosphorus SDS values compared to the other subjects (P=.003). However, of the patients and caregivers who reported that serum phosphorus levels were "controlled," 46% were hyperphosphatemic. Furthermore, 73% and 87% of patients and caregivers reported that following a phosphorus-restricted diet and taking phosphorus binders were "easy"; yet, 40% and 49% of these patients were hyperphosphatemic, respectively. In the present study, elevated serum phosphorus levels were most common in adolescent dialysis patients. There also appears to be a disconnect between the perceived ease of following a phosphorus-restricted diet and taking phosphorus binders and the achievement of normal serum phosphorus levels. These data further emphasize the importance of ongoing education regarding dietary and medical management requirements.

Risk Factors for Peritonitis in a Pediatric Dialysis Program in Guatemala, 2011–2014

Background. Peritonitis is the most common complication of peritoneal dialysis but there is limited data regarding peritonitis related risk factors in developing countries. Objective. Describe the PD program at Foundation for Children with Kidney Disease (FUNDANIER), in Guatemala, and identify peritonitis related risk factors in these patients. Methods. This retrospective open cohort study included medical records from FUNDANIER during 2011 to 2014. Baseline demographics, treatment modalities, caregivers’ characteristics, and socioeconomic status were recorded. Results. Eighty-nine medical records were included with a treatment time of 1855 months. Median age of patients was 11.3 years (range 6–17). Median duration of PD therapy was 20.8 months (range 1–28). Sixty-eight peritonitis episodes were registered; forty-eight patients (54%) remained peritonitis-free. Median time to first peritonitis episode was 5 months (range 2–16). Peritonitis rate was one episode every 27 months or 0.44 episodes per patient-year. Peritonitis rate in patients with fair housing was 2.5 times higher than in those with good housing (CI = 1.0–5.2, p=0.01). Conclusion. Housing conditions are a relevant risk factor related to peritonitis. Strategies toward preventing peritonitis must consider housing status, establishing adequate follow-up in high-risk patients. Close monitoring of technique serves to overcome understaffing issues in this setting.

Paediatric Renal Dialysis at the End of the 20th Century in Ibadan Nigeria

Aim: To document the conditions requiring dialysis in children at the University College Hospital, Ibadan Nigeria, at the end of the 20 century, as well as the available dialytic modalities and shortterm outcomes of dialysis for future comparisons. Patients and Methods: The data of all children aged 15 years and below who underwent peritoneal dialysis or haemodialysis in the Dialysis Unit between January 1990 and December 1999 were reviewed. A descriptive analysis of patients’ demography, aetiology of kidney failure, dialytic modalities and short-term outcome in these patients was performed. The primary outcome measure was mortality. Results: Sixty-six children comprising 14 (21%) boys and 52 (79%) girls underwent dialysis. The mean age was 11.9 (SD 3.9) years. Fifty-eight (88%) underwent peritoneal dialysis and 8 (12%) haemodialysis. A definitive diagnosis of Stage 5 chronic kidney Disease was made in 25 (38%), acute kidney injury in 23(35%) and acute kidney injury-on-chronic kidney disease in 6 (8%).The major underlying conditions were the nephrotic syndrome, acute glomerulonephritis and chronic glomerulonephritis. Others were diethylene glycol poisoning, malignancies and sepsis. Only acute Original Research Article Asinobi and Ogunkunle; BJMMR, 11(5): 1-9, 2016; Article no.BJMMR.20470 2 dialysis was offered because of limited resources. Overall 25 died, giving a mortality rate of 37.9% with 12 (48%) and 22 (88%) patients dying within 3 days and 2 weeks of presentation respectively. Thirteen of the 25 (52%) patients in Stage 5 CKD, and 9 (39.1%) of the 23 with AKI, died and the mortalities were related more to the aetiologies. Conclusion: Acute glomerulonephritis and Nephrotic syndrome were the major causes of AKI while chronic glomerulonephritis was the major identified cause of Stage 5 CKD. The available dialytic modalities were peritoneal dialysis and the then newly introduced haemodialysis. Patients had no insurance cover and paid out of pocket for treatment thereby limiting the duration of dialysis. The short-term outcome compared favourably with outcomes in centres with similar predicaments.