Chronic peritoneal dialysis in Chinese infants and children younger than two years.
OBJECTIVE
To review the outcome for Chinese infants and young children on chronic peritoneal dialysis.


METHODS
The Paediatric Nephrology Centre of Princess Margaret Hospital is the designated site offering chronic dialysis to children in Hong Kong. Medical records of children who started chronic peritoneal dialysis before the age of 2 years, from 1 July 1995 to 31 December 2013, were retrieved and retrospectively reviewed.


RESULTS
Nine Chinese patients (male-to-female ratio, 3:6) were identified. They were commenced on automated peritoneal dialysis at a median age of 4.7 (interquartile range, 1.1-13.3) months. The median duration of chronic peritoneal dialysis was 40.9 (interquartile range, 22.9-76.2) months. The underlying aetiologies were renal dysplasia (n=3), pneumococcal-associated haemolytic uraemic syndrome (n=3), ischaemic nephropathy (n=2), and primary hyperoxaluria I (n=1). Peritonitis and exit-site infection rate was 1 episode per 46.5 patient-months and 1 episode per 28.6 patient-months, respectively. Dialysis adequacy (Kt/Vurea>1.8) was achieved in 87.5% of patients. Weight gain was achieved in our patients although three required gastrostomy. Four patients were delayed in development. All patients survived except one patient with primary hyperoxaluria I who died of acute portal vein thrombosis following liver transplantation. One patient with pneumococcal-associated haemolytic uraemic syndrome had sufficient renal function to be weaned off dialysis. Four patients received deceased donor renal transplantation after a mean waiting time of 76.7 months. Three patients remained on chronic peritoneal dialysis at the end of the study.


CONCLUSIONS
Chronic peritoneal dialysis is technically difficult in infants. Nonetheless, low peritonitis rate, low exit-site infection rate, and no chronic peritoneal dialysis-related mortality can be achieved. Chronic peritoneal dialysis offers a promising strategy to bridge the way to renal transplantation.
Paediatric Nephrology Centre, Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
Y H
YH
Chan
Paediatric Nephrology Centre, Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
A Lt
AL
Ma
Paediatric Nephrology Centre, Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
P C
PC
Tong
Paediatric Nephrology Centre, Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
W M
WM
Lai
Paediatric Nephrology Centre, Department of Paediatric and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
N Kc
NK
Tse
D001424:Bacterial Infections / Q000453:epidemiology; D002408:Catheters, Indwelling; D002657:Child Development; D005260:Female; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000941:ethics; D010538:Peritonitis / Q000453:epidemiology; D012189:Retrospective Studies
Infant; Peritoneal dialysis; Treatment outcome