Re-evaluating criteria for peritoneal dialysis in "classical" (D+) hemolytic uremic syndrome.
BACKGROUND
Indications for peritoneal dialysis in children with post-dysenteric hemolytic uremic syndrome (D+ HUS) have not been thoroughly evaluated. Although early institution of dialysis may reduce mortality, the procedure has attendant complications.


OBJECTIVE
To determine whether the use of more stringent criteria for instituting dialysis had a better outcome to that of using conventional criteria.


METHODS
Following an outbreak of Shigella dysenteriae type 1 D+ HUS in KwaZulu/Natal during June 1994 to October 1995, we compared the renal outcome and mortality between two periods: before May 1995 (69 children) when conventional criteria for dialysis were employed and after May 1995 (70 children) when more stringent criteria for dialysis were applied.


RESULTS
The mean age of presentation was 35 months, 79 (56.8%) were males. Both groups were comparable except for gut perforation, which was more frequent before May 1995, and hypertension and severe disease, which were more frequent after May 1995. Seventy patients underwent dialysis, 36 (52.2%) before May 1995. There were no significant differences in renal outcome or death following discharge from hospital in both groups. Overall mortality was 20.1%, 15 (53.6%) of the 28 children that demised presented before May 1995.


RESULTS
Accordingly, although children with more severe disease and a higher frequency of hypertension presented after May 1995, there were no significant differences in morbidity or mortality in those using stringent criteria for dialysis, compared to those in whom conventional criteria were used.


CONCLUSIONS
We showed that several children, who would previously have been dialyzed, may be managed conservatively, without an increase in mortality or morbidity.
Department of Pediatrics and Child Health, Faculty of Medicine, University of Natal, Center for Epidemiological Research, South Africa. bhimma@med.und.ac.za
R
R
Bhimma
H M
HM
Coovadia
M
M
Adhikari
C A
CA
Connolly
D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002985:Clinical Protocols; D004405:Dysentery, Bacillary / Q000150:complications*; D005260:Female; D006463:Hemolytic-Uremic Syndrome / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects; D012307:Risk Factors; D012762:Shigella dysenteriae; D013019:South Africa; D016896:Treatment Outcome