资源有限环境下儿童急性腹膜透析后的长期生存情况

Long-term survival of children following acute peritoneal dialysis in a resource-limited setting.

作者信息

Alao Michael Abel, Ibrahim Olayinka Rasheed, Asinobi Adanze Onyenonachi, Akinsola Akinwale

机构信息

Department of Paediatrics, Bowen University Teaching Hospital, Nigeria & Bowen University College of Medicine, Ogbomosho, Nigeria.

Department of Paediatrics, Federal Medical Centre, Katsina, Nigeria.

出版信息

Kidney Res Clin Pract. 2020 Dec 31;39(4):469-478. doi: 10.23876/j.krcp.20.055.

DOI:10.23876/j.krcp.20.055

PMID:33024063

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7770994/

Abstract

BACKGROUND

There is a paucity of data on long term-outcomes of children who undergo acute peritoneal dialysis (PD) in resource-limited settings. We reviewed the outcomes of children who underwent PD after 18 months of follow-up.

METHODS

We conducted a prospective cohort study in children with acute kidney injury (AKI) who underwent PD. Diagnosis of AKI was based on the 2012 Kidney Disease: Improving Global Outcomes definition. We assessed outcomes of in-hospital mortality, 18-month post-dialysis survival, factors associated with survival, and progression to chronic kidney disease (CKD).

RESULTS

Twenty-nine children with a median age of 6 (3 to 11) years underwent acute PD. In-hospital mortality was 3/29 (10.3%) and rose to 27.6% during follow-up. Seven (24.1%) children were lost to follow-up. Of the 14 remaining children, six (42.9%) experienced full recovery of renal function, while eight (57.1%) progressed to CKD. Among those who experienced full recovery, median (interquartile range) estimated glomerular filtration rate (eGFR) rose from 12.67 (7.05, 22.85) mL/min/1.73 m2 to 95.56 (64.50, 198.00) mL/min/1.73 m2, P = 0.031. No significant changes in median eGFR from baseline were observed among those who progressed to CKD (P = 0.383) or in non-survivors (P = 0.838). According to Kaplan-Meier curve analyses, 18-month survival during follow-up was 66.0% (95% CI, 45.0% to 86.5%). Age < 5 was associated with greater likelihood of survival (OR, 3.217; 95% CI, 1.240 to 8.342).

CONCLUSION

Progression of post-PD AKI to CKD occurred in more than half of survivors. Age < 5 was associated with greater likelihood of survival.

摘要

背景

在资源有限的环境中，关于接受急性腹膜透析（PD）的儿童长期预后的数据很少。我们回顾了接受PD治疗18个月后的儿童的预后情况。

方法

我们对接受PD治疗的急性肾损伤（AKI）儿童进行了一项前瞻性队列研究。AKI的诊断基于2012年改善全球肾脏病预后组织的定义。我们评估了住院死亡率、透析后18个月生存率、与生存相关的因素以及进展为慢性肾脏病（CKD）的情况。

结果

29名中位年龄为6岁（3至11岁）的儿童接受了急性PD治疗。住院死亡率为3/29（10.3%），随访期间升至27.6%。7名（24.1%）儿童失访。在其余14名儿童中，6名（42.9%）肾功能完全恢复，而8名（57.1%）进展为CKD。在那些完全恢复的儿童中，中位（四分位间距）估计肾小球滤过率（eGFR）从12.67（7.05，22.85）mL/min/1.73 m²升至95.56（64.50，198.00）mL/min/1.73 m²，P = 0.031。在进展为CKD的儿童（P = 0.383）或非幸存者（P = 0.838）中，未观察到中位eGFR相对于基线有显著变化。根据Kaplan-Meier曲线分析，随访期间18个月生存率为66.0%（95%CI，45.0%至86.5%）。年龄<5岁与更高的生存可能性相关（OR，3.217；95%CI，1.240至8.342）。