Complications of Acute Peritoneal Dialysis in Children with Acute Kidney Failure

Background: Acute kidney injury is the sudden failure of kidneys to maintain body homeostasis and acute peritoneal dialysis is a life saving bedside mode of its management. However, complications like peritonitis, leakage, obstruction and malposition of catheter can occur during acute peritoneal dialysis. Objectives: To document the immediate complications of acute peritoneal dialysis in children having acute kidney injury. Study type, settings and duration: Descriptive case series done at department of Pediatric Nephrology, National Institute of Child Health Karachi, from July 2007 – July 2008. Subjects and Methods: Children between 1 month to 14 years of age who had acute kidney injury and underwent acute peritoneal dialysis were included in the study. All had standard indications for dialysis, catheter insertion technique and manual exchanges. Data including age, gender, indications, cause of acute kidney injury and complications, were computed on SPSS -10 and analyzed using descriptive statistics. Results: A total of 126 children underwent acute peritoneal dialysis for various indications and among them 60 developed different complications. There were 34(56.6%) boys and 26(43.3%) girls with a mean age of 4.7 years. Indications for acute peritoneal dialysis were oligo-anuria in 52(86.6 %), metabolic acidosis in 42(70%), fluid overload in 32(53.3%), uremia in 27(45%) electrolyte imbalance in 17(28.3%) and severe hypertension in 2(3.3%). Etiologies for acute kidney injury were sepsis in 15(25%), renal calculi in 14(23.3%), congenital obstructive uropathy in 10(16.7%), acute gastroenteritis in 7(11.7%) and hypoplastic kidneys in 6(10%) cases. Mean duration of acute peritoneal dialysis was 5.2 days. Documented complications were peritonitis in 19(31.7%), catheter obstruction in 13(21.7%), leakage and catheter displacement in 11(18.3%), bleeding and other complications in 3(5%). Conclusions: Acute peritoneal dialysis is a life saving procedure. Peritonitis, catheter obstruction, leakage and displacement were the common complications. Policy message: Peritoneal dialysis for children should be available at all tertiary care hospitals and its staff should undergo regular training to manage the complications..