Division of Nephrology, Department of Pediatrics, University Hospital of Kinshasa, 58820University of Kinshasa, Democratic Republic of Congo.
Division of Nephrology, Department of Pediatrics, Clinique de l'Espérance, CHC, Liège, Belgium.
Perit Dial Int. 2020 Sep;40(5):504-508. doi: 10.1177/0896860819887286. Epub 2020 Jan 17.
In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.
在刚果民主共和国（DRC），由于贫困、儿科肾脏病学合格医疗保健提供者的缺乏以及缺乏儿科透析计划，急性肾损伤（AKI）导致儿童死亡率居高不下。我们旨在描述刚果民主共和国第一家儿科急性腹膜透析（PD）计划的最新经验。这是一项回顾性队列研究，研究了 2018 年 1 月至 2019 年 1 月期间因 AKI 入住金沙萨大学医院并接受 PD 治疗的儿童的流行病学、临床特征和结局。该儿科 PD 计划由一名医生和一名护士组成的团队启动，他们在贝宁共和国接受了 PD 液的本地生产和床边导管插入技术培训。培训由弗拉芒联合大学理事会（VLIR）TEAM 项目和 ISN、ISPD、EuroPD 和 IPNA 的拯救年轻生命（SYL）项目联合支持。2018 年 1 月至 2019 年 1 月，49 名儿童（年龄 4 个月至 15 岁）因严重疟疾和败血症入院治疗 AKI。在 49 名儿童中，有 35 名（71.4%）需要透析，其中 32 名（91.4%）接受 PD 治疗，2 名在成人病房接受血液透析（HD）治疗，1 名入院后死亡。转院接受 HD 治疗的两名患者的数据无法进行随访。主要适应症是尿毒症和长时间无尿。在 32 名接受透析的患者中，24 名（75%）在出院后 3 个月恢复正常肾功能。32 名患者中有 2 名（6.2%）发生腹膜炎，死亡率为 18.7%。这一令人鼓舞的经验证明，通过使用包括本地生产的透析液和低腹膜炎发生率在内的简单手段，我们可以有效地拯救 AKI 患儿的生命。
