Peritoneal Dialysis in Emergency in Children: Mono Centric Study in a Service of Adult Nephrology of Eastern Algeria
Author(s): Missoum S, Khellaf G, Bouderda Z, Hammouche M, Rayane T
Introduction: Urgent peritoneal dialysis (PD) is very often the only possible technique for extra-renal dialysis in children in developing countries, mainly due to a lack of adequate hemodialysis equipment.
Patients and methods: Over a period of 4 years (2015-2018) we identified 36 children who required emergency PD, including 14 girls and 22 boys, the average age is 42 months (range 1month to 9 years) , the average weight of 14.6 kg (3.1 kg to 25 kg). The technique used is the continuous acute DP with a Tenckhoff catheter, the volume of the intra peritoneal dialysate and the stasis times are in accordance with the European guidelines of 2014, the solutes used are the isotonic and punctually more concentrated solutions. All these parameters vary from one patient to another according to the desired objective.
Results: Of our 36 young, 23 had an acute kidney injury AKI (02 septic shock, 09 tubular necrosis, 10 haemolytic and uremic syndromes, 02 obstructive AKI that were difficult to derivate), 13 with end stage chronic kidney disease CKD(congenital uropathy), the mean KT/V was 3.9 and the average UF 3.6 ml/kg/h, we had only two deaths due to complications of the initial pathology (septic shock). We did not have leaks or peritonitis, the most frequent complication was paradoxically hypokalemia (55% of cases), for AKI recovery of renal function was total in 100% of cases, for 13 cases of end stage CKD shift to chronic DP and pre-renal transplant checkup is the rule.
Discussion: Our results are encouraging; the management of dialysis emergencies in children in an adult Nephrology service is a real challenge. A motivated and available technical platform has adapted to their care, emergency PD in children are increasingly present in our daily lives.
Conclusion: Emergency PD in children is not only a necessity imposed by the lack of pediatric hemodialysis equipment, but a method in itself and very effective.