Peritoneal Dialysis In Infants Research Articles

Serum Inflammatory Cytokines and Peritoneal Dialysis in Infants with Acute Renal Failure Following Open Heart Surgery

Background: Acute Renal Failure (ARF) is a common complication after open heart surgery with Cardiopulmonary Bypass (CPB) because of the capillary leak syndrome. Peritoneal Dialysis (PD) has been widely used to treat ARF after CPB. In this study, the clearance of inflammatory cytokines of PD in infants with ARF following open heart surgery was investigated. Methods: Twenty-nine infants with ARF following open heart surgery who underwent PD were divided into survival and nonsurvival groups. Clinical records were reviewed to document clinical features, operative procedures, and perioperative courses. The serum inflammatory cytokine levels, including those of Tumor Necrosis Factor (TNF)-a, interleukin (IL)-6, IL-8, and IL-10, were measured perioperatively. Results: There was no difference in the preoperative characters between the 2 groups. Longer CPB time, duration of mechanical ventilation, duration from surgery to the beginning of PD, and higher central venous pressure appeared in the nonsurvival group. The serum concentrations of IL-6 and IL-8 were significantly higher in the nonsurvival group than in the survival group before PD and on PD 1 day, PD 4 days, and PD 7 days, respectively. The serum concentrations of IL-10 were higher in the nonsurvival group than in the survival group on PD day 4 and PD day 7, respectively. There were no significant differences of TNF-a between the 2 groups during the perioperative period and PD. Conclusion: PD could eliminate inflammatory cytokines effectively in patients with mild ARF after open heart surgery.

Study protocol and statistical analysis plan for the Early Peritoneal Dialysis in Infants after Cardiac Surgery (EPICS) trial

Background: Peritoneal dialysis (PD) is a commonly used therapy after infant cardiac surgery. It is unclear whether early PD commenced soon after admission to an intensive care unit (ICU) after cardiac surgery results in better outcomes. Objective: To describe the study protocol and statistical analysis plan for the Early Peritoneal Dialysis in Infants after Cardiac Surgery (EPICS) trial. Design, setting, participants and intervention: The EPICS trial is an open, randomised, two-group, single-centre clinical study of infants ≤ 180 days of age who had cardiac surgery (in Risk-Adjusted Classification for Congenital Heart Surgery version 1 categories 3-6) with cardiopulmonary bypass. Participants will be randomly assigned 1:1 to early PD (treatment group) or no early PD (control group). Those assigned to the treatment group will begin receiving PD soon after ICU admission and continue receiving it for 24 hours. Those in the control group will not receive PD during the first 24 hours. Main outcome measures: The primary outcome is a composite measure consisting of one or more of death, cardiac arrest, emergency chest reopening, and requirement for extracorporeal membrane oxygenation (ECMO) within 90 days. The main secondary outcomes are duration of mechanical ventilation, ICU length of stay, hospital length of stay, vasoactive-inotropic score at 24 hours, and cumulative per cent fluid balance by end of Day 2. At Day 90, events such as mortality, requirement for ECMO, cardiac arrest, chest reopening, volume of packed red blood cell transfusion, postoperative infection, readmission to ICU, renal injury and brain injury will be assessed. Conclusions: The EPICS trial aims to evaluate the role of early PD after infant cardiac surgery in lowering the rate of a composite major outcome. In addition, it will test the effect of early PD on duration of mechanical ventilation, and on ICU and hospital length of stay. Trial registration: ACTRN12617001614381.

Prevalence and predictors of postoperative peritoneal dialysis in infants.

Data regarding predictors of the eventual need for postoperative peritoneal dialysis in infants undergoing open heart surgery is still limited. We aimed to determine whether prolonged cardiopulmonary bypass time, surgical complexity classified according to Risk Adjustment for Congenital Heart Surgery category, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis. We retrospectively analyzed data of 181 infants who underwent open heart surgery at our institution from January 1 to December 31, 2018. Cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery category, age, body weight, and the need for postoperative peritoneal dialysis were recorded and analyzed. Thirteen (7.2%) of the 181 patients required postoperative peritoneal dialysis. This group was found to have a longer cardiopulmonary bypass time, younger age, and lower body weight. Longer cardiopulmonary bypass time (p = 0.001), higher Risk Adjustment for Congenital Heart Surgery category (p = 0.018), younger age (p < 0.001), and lower body weight (p < 0.001) significantly increased the risk of postoperative peritoneal dialysis. Longer cardiopulmonary bypass time, more complex surgery, younger age, and lower body weight increase the probability of requiring postoperative peritoneal dialysis in infants undergoing open heart surgery.

Chronic peritoneal dialysis in children

Chronic kidney failure is rare in children and adolescents. The availability and types of kidney replacement therapy (KRT) vary widely, with a global prevalence of 18–100 per million age-related population (pmarp). Approximately 1000 children are on KRT in the UK (prevalence 64.8 pmarp). Almost 25% are on dialysis. Chronic peritoneal dialysis (PD) is the dialysis modality of choice in younger children given its almost universal applicability, cost-effectiveness and the possibility of a home-based treatment. This is most compatible with a child's schooling and social life. Advances in technology have improved outcomes even for the youngest children, but mortality remains high and the morbidity and burden of care should not be underestimated. Optimal management of children on dialysis requires a multidisciplinary team and consideration of the child and family's expectations. With few high-quality randomized trials, clinicians are reliant on prospective cohort studies and international registries to inform and improve management strategies. Children on dialysis have a lifetime of KRT ahead of them. The selection of dialysis modality and management must consider the principles of dialysis access preservation. This review summarizes current epidemiology, principles of dialysis, PD access, modalities, prescriptions and complications of PD, as well as a brief discussion on PD in infants with their unique ethical and technical considerations.

Successful peritoneal dialysis using a percutaneous tube for peritoneal drainage in an extremely low birth weight infant: a case report

BackgroundPeritoneal dialysis (PD) for acute kidney injury (AKI) of newborns has been performed safely. AKI occurs in 8 to 24% of extremely low birth weight (ELBW) infants. Although PD has only been used occasionally in ELBW infants, prognosis is poor for ELBW infants with AKI. Several reports have described successful PD in these infants, but no guideline-based evidence concerning indications for renal replacement therapy in ELBW infants are currently available. Here, we report on our experience with PD in an ELBW infant with AKI resulting from septic shock.Case presentationA male was born at 24 weeks and 3 days gestation weighing 264 g by emergency cesarean section due to complications of pregnancy in a patient with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. On day of life (DOL) 15, the inability to ventilate, along with cardiovascular dysfunction, acute kidney injury, and ascites under tension led to the tentative diagnosis of abdominal compartment syndrome (ACS). On DOL 17, placement of a percutaneous drainage tube immediately released compression of the tense abdomen. Although intra-abdominal pressure reduction with percutaneous drainage temporarily improved respiratory status, circulatory impairment persisted and infections were not well controlled. Finally, the patient developed anuria. On DOL 21, peritoneal dialysis (PD) was started by initially inserting a drainage tube. Although the patient had catheter-associated peritonitis, urine output improved by DOL 44 and PD was discontinued on DOL 53. On DOL 75, extubation was conducted without circulatory dysfunction. The patient was discharged on DOL 224.ConclusionsWe emphasize that starting PD treatment before the onset of anuria is important in ELBW infants with AKI. Although the catheter used in our case was initially inserted for drainage of ascites, this type of catheter is sufficiently useful for PD in ELBW infants, and PD using a drainage tube may represent a safe, effective, and minimally invasive treatment for ELBW infants. To our knowledge, this is the first report to describe the use of a percutaneous tube to conduct successful PD for peritoneal drainage in an ELBW infant. This is the lowest-weight ELBW infant with successful PD reported to date.

Early peritoneal dialysis in infants after surgery

Early peritoneal dialysis in infants after surgery

Peritoneal dialysis in infants: the experience of the Italian Registry of Paediatric Chronic Dialysis

Although chronic peritoneal dialysis (CPD) is considered the replacement therapy of choice for infants with end-stage renal failure, many questions persist about treatment risks and outcomes. We present data on 84 infants who started CPD at <1 year of age; these patients represent 12% of the total population of the Italian Registry of Paediatric Chronic Dialysis. We analysed patient records from all children consecutively treated with CPD between 1995 and 2007 in Italy. Growth data analysis was performed only in infants with complete auxological parameters at 0, 6 and 12 months of follow-up. Median age at the start of CPD was 6.9 months, weight was 6.1 kg and length 63.6 cm. In one-half of the study population diagnosis leading to renal failure was congenital nephrouropathy. Twenty-eight per cent of the children had at least one pre-existing comorbidity. The mean height standard deviation score was -1.65 at the start of CPD, -1.82 after 12 months and -1.53 after 24 months. Catch-up growth was documented in 50% of patients during dialysis. A positive correlation was observed between longitudinal growth and both exchange volume (R(2) = 0.36) and dialysis session length (R(2) = 0.35), while a negative association was found with the number of peritonitis cases (P = 0.003). Peritonitis incidence was 1:20.7 episode:CPD-months (1:28.3 in the older children from the same registry) and was significantly higher in children with oligoanuria (1:15.5 episode:CPD-months) compared to infants with residual renal function (1:37.4 episode:CPD-months). Catheter survival rate was 70% at 12 months and 51% at 24 months. Catheter-related complications were similar in infants and older children (1:20.5 versus 1:19.8 episode:CPD-months), while clinical complications were more frequent in children under 1 year of age (1:18.3 versus 1:25.2 episode:CPD-months; P < 0.05). During the follow-up period, 33 patients were transplanted (39.3%), 18 were shifted to haemodialysis (21.4%) and 8 died (9.5%). The mortality rate was 4-fold greater than in older children (2.3%). Our data confirm that infants on CPD represent a high-risk group; however, our experience demonstrated that growth was acceptable and a large portion was successfully transplanted. Increased efforts should be aimed at optimizing dialysis efficiency and preventing peritonitis. The higher mortality rate in infants was largely caused by comorbidities.

Peritoneal Dialysis in Infants and Young Children

Although end-stage renal disease is rare in infants and young children, its development can be associated with significant morbidity and mortality and only through the provision of experienced, multidisciplinary care can a favorable outcome be anticipated. Peritoneal dialysis is the renal replacement modality of choice for this age group and serves as an essential bridge until successful renal transplantation can occur. In this review, we discuss the practice of peritoneal dialysis in infants including the unique ethical and technical considerations facing pediatric nephrologists and caregivers. In addition, we review current guidelines concerning nutrition, growth, and adequacy, as well as the literature on complications and outcomes.

Clinical research Successes and pitfalls of chronic peritoneal dialysis in infants – a Polish nationwide outcome study

IntroductionPeritoneal dialysis (PD) is a preferred method of renal replacement therapy for end-stage renal disease in children. Recent advances have allowed chronic PD to be provided to children of all ages and sizes.Material and methodsThe study was designed as a national (10 dialysis centres), multicentre retrospective analysis of the medical history of 33 children who started chronic peritoneal dialysis in their infancy between 1993 and 2005, with a follow-up period of at least 24 months.ResultsThe nutritional status of the infants was unsatisfactory. The mean SDS of body weight at the start was –2.0, at 1 year of age –1.7. Only 40% of infants were adequately nourished at 1 year of age. Long-term follow-up analysis showed that 12 children received a kidney transplant, 13 were still on dialysis (4 changed method) and 6 died (mortality rate in the first year of life of 9%). In 2 children we observed an improvement of renal function. We observed a relatively high (1/8.8 patient-months) peritonitis rate in the analysed children when compared to 1 : 22 patient-months in all children undergoing PD in Poland.ConclusionsThe results of our survey have shown that the management of dialysed infants is still a challenge for the medical team and families, but long-term results of the therapy are encouraging.

Peritoneal Dialysis in Infants and Children After Open Heart Surgery

Infants and children who undergo surgical repair of complex congenital heart diseases are prone to developing renal dysfunction. The purpose of this study was to investigate the risk factors associated with prolonged peritoneal dialysis (PD) and the mortality of pediatric patients with acute renal failure (ARF) after open heart surgery. From June 1999 to May 2007, a total of 542 children underwent open heart surgery for congenital heart disease. Fifteen (2.8%) experienced ARF and seven (1.3%) required PD. The clinical and laboratory variables were compared between the survivor and non-survivor groups of ARF patients that needed PD. The non-survivors (n=3, 43%) had a Longer cardiopulmonary bypass time (154+/-21 vs. 111+/-8 minutes, p=0.012) and longer aorta clamping time (92+/-40 vs. 66+/-15 minutes, p=0.010) than the survivors (n=4, 57%). Before the PD, the pH and base excess of the arterial blood gas analysis in the survivors was much higher than that non-survivors (7.30+/-0.04 vs. 7.16+/-0.10, p=0.039; -5.15+/-3.13 vs. -12.07+/-2.9mmol/L, p=0.031). Furthermore, the survivors had a shorter interval between the onset of ARF and the day the PD was begun (1.2+/-0.4 vs. 4.3+/-1.2 days, p=0.001), and shorter duration of PD (6.6+/-2.7 vs. 13.0+/-3.5 days, p=0.036) than non-survivors. Early intervention with PD is a safe and effective method for managing patients with ARF after open heart surgery. The cardiopulmonary bypass and aortic clamping duration, time of initiating PD, duration of the PD, sepsis, and relative complications may predict the prognosis of these patients.

Use of the Multipurpose Drainage Catheter for the Provision of Acute Peritoneal Dialysis in Infants and Children

Prior experience with the Cook (Cook Inc, Bloomington, IN) Teflon rigid catheter (CTC) showed it to be a suboptimal access for acute peritoneal dialysis (PD) treatment in infants and children because of the frequency of catheter-related complications associated with its use. The objective of this study is to report our experience with the bedside-placed flexible Cook Mac-Loc Multipurpose Drainage catheter (CMMDC) for acute PD in critically ill infants, comparing it with the historic Tenckhoff catheter (TC) and CTC use. Retrospective cohort study. All patients with acute renal failure (ARF) seen in our institution between December 2003 and April 2005 who underwent CMMDC placement for acute PD are included. CTCs versus CMMDCs versus TCs. Catheter-related complications and catheter-free survival. 21 infants and children with ARF were treated with acute PD using a CMMDC; 16 patients were post-cardiac surgery and 5 had other diagnoses. Mean patient age was 6.9 +/- 14.4 (SD) months (range, 4 days to 5.2 years; median, 1.6 months). Of 21 catheters, 3 had complications, and in 2 patients, this precluded continuation of PD therapy. In the remaining 18 patients, catheter use continued until recovery from ARF or nonrenal death. All patients achieved target fluid and solute removal with no catheter-related infectious complications. Mean complication-free survival of CMMDCs was 10.5 +/- 7.9 days (range, 2 to 29 days), with the 90% probability of survival at 14 days. Although there was no significant difference between lengths of complication-free survival of CMMDCs and TCs (58 days; P = 0.57), the difference between CMMDCs and CTCs (6 days) was significant (P < 0.001). Likewise, incidences of catheter-related complications with TCs and CMMDCs were similar, and in both cases, significantly less than the incidence associated with CTCs (49%; P < 0.01). Small number of patients and comparison with historic experience. Use of CMMDCs is associated with the provision of effective dialysis with a satisfactory complication-free survival and should be considered when bedside placement of an acute PD access in infants and children is desired.

Peritoneal dialysis in infants

The need for maintenance dialysis for infants is rare, but peritoneal dialysis has been the modality of choice in cases of end-stage renal failure, for technical reasons. Problems include higher mortality rates and an inferior long-term outcome compared with that in older children. Also, no internationally accepted guidelines exist for dialysis in infants. Many children on maintenance peritoneal dialysis in Finland have congenital nephrotic syndrome of the Finnish type (NPHS1), and dialysis is started during infancy. In this commentary we discuss our practice of performing peritoneal dialysis in infants and experiences gathered from the literature.

Long-term outcome of peritoneal dialysis in infants

Debate continues concerning the treatment of infants with end-stage renal disease. We evaluated progress and outcome of 20 infants with a mean age of 0.34 year (range, 0.02-1 year) in a long-term peritoneal dialysis program at a single center. Mean weight at the start of dialysis was 4.8 kg (range, 1.7–11.4 kg), and the duration of dialysis was 17.3 months (range, 1–59 months). Eleven infants received renal transplants, 4 were switched to hemodialysis and then received transplants, 4 died, and 1 continues to receive peritoneal dialysis. There was significant co-morbidity in 6 infants who died or required hemodialysis. Catheter interventions were frequent, with 12 infants requiring at least one replacement. There were 1.1 episodes of peritonitis per patient-year; 70% of infants had 0 to 1 episode. Mean weight standard deviation score (SDS) was −1.6 at the start, −0.3 at 1 year (P = .0008), and 0.3 at 2 years (P = .0008). Height SDSs were −1.8 at the start, −1.1 at 1 year (P = .046), and −0.8 at 2 years (P = .06). Head circumference SDSs were −1.9 at the start, −1.3 at 6 months (P = .003), and −0.9 at 1 year (P = .015). Fourteen of 16 survivors are achieving normal developmental milestones or attend mainstream school. Peritoneal dialysis in infancy is a demanding treatment, but outcome for growth, development, and transplantation justifies this intensive approach. When parents are counseled, the importance of non-renal co-morbidity must be emphasized.

Peritoneal Dialysis in Infants, Children, and Adolescents

Peritoneal Dialysis in Infants, Children, and Adolescents

Problems of Continuous Ambulatory Peritoneal Dialysis in Infants

Problems of Continuous Ambulatory Peritoneal Dialysis in Infants

Low volume peritoneal dialysis in newborns and infants

Peritoneal dialysis has been widely considered to be the dialytic treatment of choice for acute renal failure in infants and young children, because the technique is simple, safe and easily adapted for these patients. Also peritoneal dialysis in infants might have more effective ultrafiltration and clearance than in adults. In certain circumstances associated with hemodynamic instability, ordinary volume peritoneal dialysis(30-50 ml/kg body weight per exchange) or hemodialysis may not be suitable unfortunately. But frequent cycled, low volume, high concentration peritoneal dialysis may be more available to manage the hemodynamically untable acute renal failure of newborns and infants. Seven infants underwent peritoneal dialysis for hemodynamically unstable acute renal failure with low exchange volume(), short exchange time(30 to 45 minutes) and hypertonic glucose solution(4.25% dextrose). Age was months and body weight was . Etiology of acute renal failure was secondary to sepsis with or without shock(5 cases) and postcardiac operation(2 cases). Catheter was inserted percutaneously with pigtail catheter or Tenkhoff catheter by Seldinger method. Dialysate was commercially obtained Peritosol which contained sodium, chloride, potassium, magnesium, lactate and calcium. Net ultrafiltration(ml/min) showed no difference between low volume dialysis and control( versus ) Blood BUN decreased from to and blood pH increased from to after 24 hours of peritoneal dialysis. We experienced hyperglycemia which were controlled by insulin(2 episodes), leakage at the exit site(2), mild hyponatremia(1) and Escherichia coli peritonitis(1). Two children of low volume dialysis died despite the treatment. In our experience, low volume and high concentration peritoneal dialysis with frequent exchange may have sufficient ultrafiltration and clearance without significant complications in the certain risked acute renal failure of infants.

Continuous Ambulatory Peritoneal Dialysis in Children in Saudi Arabia

Over a period of 5 years, 26 children with end-stage renal disease were started on maintenance continuous ambulatory peritoneal dialysis (CAPD) program in King Khalid University Hospital, Riyadh. A...

Acute peritoneal dialysis in infants weighing

Acute peritoneal dialysis in infants weighing <1500 g

A Unique Approach to Peritoneal Dialysis in Infants

Little recorded experience exists concerning the use of chronic peritoneal dialysis in the infant. We herein report the results of a multidisciplinary approach to two infants who were treated with a unique modification of “short-dwell” peritoneal dialysis. A single-bag technique was devised in the hopes of reducing glucose absorption and protein losses while concomitantly permitting a simplified manual method of cycling peritoneal dialysis. The desired nutritional needs of the infants consisted of a caloric intake of 140 calories/kg/d and a protein intake of 3.0 to 4.0 g/kg/d, a goal that often required administration through a nasogastric tube. The timely initiation of peritoneal dialysis and the strict adherence to the prescribed dietary regimen was associated with continued growth in both patients. Repeated developmental assessments of each child were conducted and revealed normal development in one patient and mild delay, but gradual improvement, in the other.

Convective Characteristics of Pediatric Peritoneal Dialysis

The convective aspects of pediatric peritoneal dialysis (PD) -fluid transfer with its attendant solvent drag -were evaluated in vivo in 8 children on maintenance PD. The evaluation was performed according to the mass transport model of pyle. Reflection coefficients were calculated for urea, creatinine, uric acid, glucose and idealized total protein. These values were compared to adult means. There were no differences in reflection coefficients, except for total protein, which had a lower value. Maximum ultrafiltration rates were also calculated for the three commercially avail able dialysate glucose concentrations (1.5%, 2.5%, 4.25%). These values were scaled for body surface area to allow comparison with adult means. All values were lower than the adult means, but were not outside two standard deviations. Convective transport in PD in children over 1 Vl years of age, does not appear to be significantly different than that in adults. There are two components to solute removal in peritoneal dialysis: diffusion and convection. Convective transport, the passive movement of solute in a solvent stream across a semipernleable membrane, is directly related to the rate of ultrafiltration. The convective component of solute removal in peritoneal dialysis may be responsible for a significant per cent of transport of larger molecular weight solutes (I). Little infornlation is currently available concerning this aspect of pediatric peritoneal dialysis. Kohaut and Alexander have reported that it is more difficult to achieve ultrafiltration in infants than in older children, adolescents, and adults (2). The convective component of peritoneal dialysis in infants may therefore contribute less to overall solute removal than in older children and adults.