Automated Peritoneal Dialysis: Clinical Experience in 32 Children

WM LAI, MC CHIU, KC TSE, SC LAU, PC TONG

We report the 6 1/2 years experience of automated peritoneal dialysis (APD) in 32 Chinese children who were put on the APD programme in the Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital since November 1996. There were 15 boys and 17 girls and the mean age of start of APD was 11.2±5.8 years (range 0.1-21.5 years). The mean duration of APD was 27.7±22.3 months (range 3-79 months). The primary diagnosis were glomerulonephropathies (40.6%), hypoplastic/dysplastic kidneys (31.3%), pyelonephritis (9.4%), and other renal diseases (18.8%). Peritoneal equilibration test showed that 14 patients (48.3%) were high transporter, 10 patients (34.5%) were high average transporter and 4 patients (13.8%) were low average transporter. Seven patients (21.8%) were on nightly intermittent peritoneal dialysis. Seventeen patients (53.1%) on continuous cyclic peritoneal dialysis (CCPD), 4 patients (12.5%) on high dose CCPD, and 3 patients (9%) on tidal peritoneal dialysis. The incidence of peritonitis rate was low with 1 infection every 80.5 patient months or annualised peritonitis rate 0.149. Causative organisms included gram positive organisms (45.5%), gram negative organisms (27.2%), atypical mycobacterium (9%), and culture negative (18.2%). The incidence of exit site infection was 1 episode per 23.5 patient months. The mean weekly Kt/V urea was 2.46±0.58 and mean combined weekly creatinine clearance was 59.3±19.5 litre/1.73 m². Eighteen patients (56.2%) remained on APD. Ten patients (31.3%) were successfully transplanted with functioning graft. One patient (3.1%) was on chronic HD and there were 3 deaths. We concluded that APD is a good dialysis modality for paediatric end stage renal failure patients and there was a low incidence of peritonitis while achieving adequate dialysis in the majority of patients. (HK J Paediatr (new series) 2004;9:44-49)

Key words : Automated peritoneal dialysis; Children

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