Deuchande Sofia, Mano Tânia, Novais Cristina, Machado Rute, Stone Rosário, Almeida Margarida
Unidade de Pediatria. Departamento da Mulher e da Criança. Hospital José de Almeida. Cascais. Portugal.
Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal.
Acta Med Port. 2016 Sep;29(9):525-532. doi: 10.20344/amp.6913. Epub 2016 Sep 30.
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.
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.
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.
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.
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.
腹膜透析是儿童慢性终末期肾病的首选透析方法。本研究的主要目的是描述在生命的头两年内开始腹膜透析的儿童群体的长期生存情况。
1991年1月至2014年8月期间，在葡萄牙一家儿科肾脏病和肾移植科进行了一项描述性回顾性研究。对终末期肾病的病因、死亡率、腹膜透析的合并症和并发症以及终末期肾病、生长发育和精神运动发育进行了评估。
20名儿童在生命的头两年内开始腹膜透析。有6例死亡，但在过去十年中没有原发性慢性肾病儿童死亡的记录。对14名存活儿童进行了特征描述；13名是男性。肾脏和尿路先天性异常是慢性肾病的主要病因（45%）。开始腹膜透析的平均年龄为6.1个月；6名儿童在出生后30天内开始透析。腹膜炎是住院的最常见原因。10名儿童在平均年龄5.3岁时接受了移植。所有仍在进行腹膜透析的儿童身材矮小，但9名接受移植的儿童最终身高在其父母身高中位数预期目标范围内。9名（64%）有某种类型的神经发育延迟。
如本研究所示，腹膜透析是一种从出生起就可行的技术，因为超过一半的儿童在6个月前成功开始透析。尽管存在相关的发病率，包括腹膜炎和慢性肾病的并发症，但它允许长期生存直至有肾移植的可能性。与透析期相比，10名接受移植的儿童生长情况改善，慢性贫血恢复，血脂异常改善。然而，直到肾移植的平均等待时间比其他国际中心高5.3年。
这些数据支持从出生起就使用腹膜透析，但并发症和生长情况较差反映出需要制定策略来优化与营养、生长发育相关的护理，并减少移植前时间。
