Peritoneal dialysis in children under two years of age.
BACKGROUND
Although results of peritoneal dialysis (PD) in small children have improved during recent years, the youngest children have poorer growth, more infections and higher mortality than do older children.


METHODS
In this retrospective study, we analysed patient records of all children under age 2 treated with continuous peritoneal dialysis (CPD) between 1995 and 2000 in Finland. Diagnoses leading to renal failure in these 23 children were congenital nephrotic syndrome of the Finnish type (13), polycystic kidney disease (4), a urethral valve (3), renal insufficiency due to neonatal asphyxia (2) and Prune-Belly syndrome (1). Of these 23, 17 (74%) were anuric.


RESULTS
The mean age at the onset of PD was 0.4 years and the mean time on dialysis 1.4 years. Hernias were diagnosed in 57%. The peritonitis rate was 1:14.5 patient-months, and 30% were peritonitis-free. Hypertension was common, and 70% had at least one period on antihypertensive medication. None of the patients had pulmonary oedema or dialysis-related seizures. The mean height standard deviation score (hSDS) at the start of PD (n = 16) was -2.0 and after 9 months -1.6. Catch-up growth was documented in 64% of the patients during dialysis. Hospitalization time was 124 days/patient-year. Two patients (9%) died.


CONCLUSIONS
Our results are reassuring. Mortality was low, laboratory parameters were acceptable and growth was good. Peritonitis rate was comparable to that in older children. Correction of inguinal hernia should be routinely performed; high blood pressure is still a problem.
Laakkonen
Hanne
H
Department of Paediatric Nephrology and Transplantation, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland. hanne.laakkonen@hus.fi
Hölttä
Tuula
T
Lönnqvist
Tuula
T
Holmberg
Christer
C
Rönnholm
Kai
K
D000367:Age Factors; D001002:Anuria / Q000628:therapy; D001238:Asphyxia Neonatorum / Q000150:complications; D002657:Child Development; D005260:Female; D005387:Finland; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009404:Nephrotic Syndrome / Q000151:congenital / Q000628:therapy; D010530:Peritoneal Dialysis / Q000009:adverse effects; D007690:Polycystic Kidney Diseases / Q000628:therapy; D011535:Prune Belly Syndrome / Q000628:therapy; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D014521:Urethra / Q000002:abnormalities