18
years) have been initiated on continuous ambulatory peritoneal dialysis
at our center over the last 32 months. Ten (43%) went on to have
successful transplantation proving the viability of pediatric continuous
ambulatory peritoneal dialysis in our scenario. Major concern identified
was a relatively high peritonitis rate of 0.85 per year of peritoneal
dialysis usage.
As per Western data, pediatric End Stage Renal
Disease (pESRD) has an incidence of 9.4 per million age related
population (pmarp) and prevalence of 56.8 pmarp [1]. Although no such
reports are available from India, with a pediatric population of over
400 million [2] the numbers are likely to be significant. In children,
peritoneal dialysis is usually preferred over hemodialysis with the
significant advantage of it being conducted at home [3]. Unfortunately
Indian data on chronic pediatric perfitoneal dialysis is limited [4]. We
retrospectively reviewed all children £18 years initiated on continuous
ambulatory peritoneal dialysis (CAPD) between January 2011 and August
2014 at our centre.
Twenty-three children were identified with median age
at last follow-up of 10.3 (range 5.1 -17.4) years (74% male). Underlying
etiologies were : congenital anomalies of kidney and urinary tract (n=6),
focal segmental glomerulosclerosis (n=4), autosomal recessive
polycystic kidney disease (n=3), nephronopthisis (n=3),
atypical Haemolytic Uremic Syndrome (n=2) and unknown etiology (n=5).
35% (n=8) needed urgent dialysis, whereas the rest were known to
be suffering from chronic kidney disease for median 4.1 (range 0.4 to
10.8) years. Median age at onset of CAPD was 9.2 (range 3-16.5) years
and median duration of CAPD was 15 (range 3- 48) months. Only 6 (23%)
were local city residents and for the rest median distance from nearest
pediatric dialysis centre was 102 (range 17 to 689) kilometre. Post
initiation, four (17%) children required catheter reposition because of
poor fluid drain, but of these, only one needed catheter change. Usual
CAPD prescription was 3 to 4 exchanges of 4 to 6 hours duration with
dwell volume of 1L/ m
In conclusion, pediatric CAPD is a viable option in
India as 43% of children finally progressed to transplantation. Although
the results are better than previous Indian reports, peritonitis and
mortality continue to be a major concern when compared to international
reports [4,6]. A likely solution might be better training for the
caregivers by institution- based peritoneal dialysis nurses and
consideration for financial support for these families [6,7].
References
1. Pruthi R, O’Brien C, Casula A, Braddon F, Lewis M,
Maxwell H, et al. UK Renal Registry 15th Annual Report:
Demography of the UK Paediatric Renal Replacement Therapy Population in
2011. Nephron Clin Pract. 2013;123:81-92.
2. Child Rights and You (CRY). Available from:
http://www.cry.org/resources/pdf/types_of_corp_parts_sep11. pdf
. Accessed October 20, 2014).
3. Just PM, de Charro FT, Tschosik EA, Noe LL,
Bhattacharyya SK, Riella MC. Reimbursement and economic factors
influencing dialysis modality choice around the world. Nephrol Dial
Transplant 2008;23:2365-73.
4. Prasad N, Gulati S, Gupta A, Sharma RK, Kumar A,
Kumar R, et al. Continuous peritoneal dialysis in children: a
single-centre experience in a developing country. Pediatr Nephrol.
2006;21:403-7.
5. Piraino B, Bernardini J, Brown E, Figueiredo A,
Johnson DW, Lye WC, et al. ISPD position statement on reducing
the risks of peritoneal dialysis-related infections. Perit Dial Int.
2011;31:614-30.
6. Schaefer F, Borzych-Duzalka D, Azocar M, Munarriz
RL, Sever L, Aksu N, et al; IPPN Investigators. Impact of global
economic disparities on practices and outcomes of chronic peritoneal
dialysis in children: insights from the International Pediatric
Peritoneal Dialysis Network Registry. Perit Dial Int. 2012;32:399-409.
7. Ramachandran R, Jha V. Kidney transplantation is
associated with catastrophic out of pocket expenditure in India. PLoS
One. 2013;8:e67812.