title: [Peritoneal Dialysis in the First Two Years of Life: Experience of a Nephrology and Renal Transplantation Pediatric Unit].
abstract: BACKGROUND
  Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life.
  
  
  METHODS
  A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated.
  
  
  RESULTS
  Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay.
  
  
  CONCLUSIONS
  Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers.
  
  
  CONCLUSIONS
  These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.
authors.affiliation: Unidade de Pediatria. Departamento da Mulher e da Criança. Hospital José de Almeida. Cascais. Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Deuchande
authors.affiliation: Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal.
authors.forename: Tânia
authors.initials: T
authors.lastname: Mano
authors.affiliation: Serviço de Pediatria. Hospital de Caldas da Rainha. Centro Hospitalar do Oeste. Caldas de Rainha. Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Novais
authors.affiliation: Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Rute
authors.initials: R
authors.lastname: Machado
authors.affiliation: Unidade de Nefrologia e Transplantação Renal Pediátrica. Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Rosário
authors.initials: R
authors.lastname: Stone
authors.affiliation: Unidade de Nefrologia e Transplantação Renal Pediátrica. Departamento de Pediatria. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Almeida
mesh_terms: D000367:Age Factors; D005260:Female; D006757:Hospital Units; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D009398:Nephrology; D010530:Peritoneal Dialysis / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate