Outcome and risk factors for mortality in pediatric peritoneal dialysis.
BACKGROUND
The mortality rate among children requiring renal replacement therapy is higher than in children without end-stage renal disease (ESRD). Some factors, such as hypoalbuminemia, high peritoneal transport rate, age, malnutrition, cardiovascular disease, and recurrent peritonitis, appear to be associated with lower survival in adult peritoneal dialysis patients. Data regarding risk factors of mortality in children with continuous ambulatory peritoneal dialysis (CAPD) are limited. The aims of this study were to analyze the clinical characteristics of patients and investigate if routinely used laboratory and clinical variables are independent risk factors for mortality in children on CAPD.


METHODS
We performed a retrospective chart analysis of pediatric ESRD patients on CAPD between January 1997 and September 2008. 29 patients undergoing CAPD for more than 3 months were enrolled. An analysis was performed on clinical and biochemical variables for survivors and nonsurvivors to identify potential risk factors for mortality.


RESULTS
Mean age was 12.18 +/- 4.57 years. During the follow-up period, 8 patients transferred to hemodialysis and 13 patients received deceased donor renal transplantation. By the end of the study, 5 patients had died. Actuarial survival rate at 2 and 5 years was 96.55% and 91.19% respectively. The major complication during therapy was peritonitis (1 episode/57.79 patient-months). In the univariate analysis, younger age at initiation of dialysis, presence of comorbid disease, higher peritoneal transport rate, increased protein losses through peritoneal dialysis, high total daily protein loss, hypoalbuminemia, and hypophosphatemia were variables associated with mortality in pediatric CAPD patients. However, in the multivariate analysis, only low serum albumin (b = -2.089, p = 0.006; hazard ratio 8.06, 95% confidence interval 0.028 - 0.546) was independently associated with mortality.


CONCLUSIONS
Mortality was low in our pediatric patients receiving CAPD. Hypoalbuminemia showed a significant association with death in CAPD patients.
Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, School of Medicine, Taipei, Taiwan.
Hsin-Lin
HL
Tsai
Ling-Yu
LY
Yang
Tai-Wai
TW
Chin
Hsin-Hui
HH
Wang
Chin-Su
CS
Liu
Chou-Fu
CF
Wei
Jei-Wen
JW
Chang
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome