title: Peritoneal dialysis for management of pediatric acute renal failure.
abstract: BACKGROUND
  While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention.
  
  
  METHODS
  Retrospective database review of children requiring PD for ARF over a 10-year period.
  
  
  METHODS
  Pediatric intensive care unit at a tertiary-care referral center.
  
  
  METHODS
  Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF.
  
  
  RESULTS
  Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 +/- 13 days. Children with ARF were younger (30 +/- 48 months vs 88 +/- 68 months old, p < 0.0001) and smaller (11.9 +/- 15.9 kg vs 28 +/- 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percutaneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was common in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%.
  
  
  CONCLUSIONS
  Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.
authors.affiliation: Division of Pediatric Nephrology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, USA. jflynn@montefiore.org
authors.forename: J T
authors.initials: JT
authors.lastname: Flynn
authors.forename: D B
authors.initials: DB
authors.lastname: Kershaw
authors.forename: W E
authors.initials: WE
authors.lastname: Smoyer
authors.forename: P D
authors.initials: PD
authors.lastname: Brophy
authors.forename: K D
authors.initials: KD
authors.lastname: McBryde
authors.forename: T E
authors.initials: TE
authors.lastname: Bunchman
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies