Long-term outcome of peritoneal dialysis in infants.
Debate continues concerning the treatment of infants with end-stage renal disease. We evaluated progress and outcome of 20 infants with a mean age of 0.34 year (range, 0.02-1 year) in a long-term peritoneal dialysis program at a single center. Mean weight at the start of dialysis was 4.8 kg (range, 1.7-11.4 kg), and the duration of dialysis was 17.3 months (range, 1-59 months). Eleven infants received renal transplants, 4 were switched to hemodialysis and then received transplants, 4 died, and 1 continues to receive peritoneal dialysis. There was significant co-morbidity in 6 infants who died or required hemodialysis. Catheter interventions were frequent, with 12 infants requiring at least one replacement. There were 1.1 episodes of peritonitis per patient-year; 70% of infants had 0 to 1 episode. Mean weight standard deviation score (SDS) was -1.6 at the start, -0.3 at 1 year (P =.0008), and 0.3 at 2 years (P =.0008). Height SDSs were -1.8 at the start, -1.1 at 1 year (P =.046), and -0. 8 at 2 years (P =.06). Head circumference SDSs were -1.9 at the start, -1.3 at 6 months (P =.003), and -0.9 at 1 year (P =.015). Fourteen of 16 survivors are achieving normal developmental milestones or attend mainstream school. Peritoneal dialysis in infancy is a demanding treatment, but outcome for growth, development, and transplantation justifies this intensive approach. When parents are counseled, the importance of non-renal co-morbidity must be emphasized.
Ledermann
S E
SE
Departments of Nephrology and Urology, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom.
Scanes
M E
ME
Fernando
O N
ON
Duffy
P G
PG
Madden
S J
SJ
Trompeter
R S
RS
D001835:Body Weight; D002404:Catheterization / Q000295:instrumentation; D002423:Cause of Death; D002508:Cephalometry; D002657:Child Development; D003376:Counseling; D004194:Disease; D005260:Female; D005500:Follow-Up Studies; D006257:Head / Q000254:growth & development; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D010538:Peritonitis / Q000209:etiology; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome