Peritoneal dialysis in children with sepsis-associated AKI (SA-AKI): an experience in a low- to middle-income country

ABSTRACT

Background: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.

Aim: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.

Methods: Early PD (n = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (n = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.

Results: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (p < 0.001). The duration of PD was less if it was commenced early (p < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (p < 0.001).

Conclusions: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.

Abbreviations : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.

KEYWORDS:

• Peritoneal dialysis
• SA-AKI
• early PD

Acknowledgment

We are grateful to the IPNA (International Pediatric Nephrology Association) for conducting the Pre-Congress Workshop on PD at Iguaçu, Brazil in 2016 and teaching AS Tenckhoff catheter insertion.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Apurva Tomar

Apurva Tomar was postgradute student in the Department of Pediatrics.

Virendra Kumar

Virendra Kumar is a pediatric intensivist with special interest in acute peritoneal dialysis.

Abhijeet Saha

Abhijeet Saha is an alumnus of Institute of Medical Sciences, Banaras Hindu University and received his training in Pediatric Nephrology at AIIMS, New Delhi (First IPNA Fellow). Subsequently he was trained at National University Hospital (Singapore), University of Heidelberg (Germany and Great Ormund Street Hospital, (London). He has established Division of Paediatric Nephrology at Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi.