Department of Paediatrics, 28856Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.
Department of Community Medicine, 28856Lady Hardinge Medical College and associated Sucheta Kriplani Hospital, New Delhi, India.
Perit Dial Int. 2021 Mar;41(2):209-216. doi: 10.1177/0896860820975897. Epub 2020 Dec 4.
Peritoneal dialysis (PD) is easily available and simple lifesaving procedure in children with renal impairment. There is paucity of reports on efficacy of PD in critically ill children in presence of shock and those requiring mechanical ventilation.
In this prospective observational study, efficacy and outcome of PD were evaluated in 50 critically ill children aged 1 month to 14 years admitted in pediatric intensive care unit of a tertiary care teaching hospital in India.
Indication of PD was acute kidney injury (AKI) in 66% of patients followed by chronic kidney disease with acute deterioration due to infectious complications in 34%. Bacterial sepsis was the most common cause of AKI (22%), others being malaria (14%) and severe dengue (12%). At initiation of PD, 26% of patients were in shock and 46% were mechanically ventilated. PD was effective and improvement in pH, bicarbonate, and lactate started within hours, with consistent improvement in estimated glomerular filtration rate by 24 h, which continued till the end of procedure, including the subgroup of patients with shock and mechanical ventilation. Total complications were seen in 14% and of which peritonitis was present in 4.0% of patients. Mortality was seen in 14% (7/50) of patients. Shock at initiation of PD (odds ratio (OR), 5.03; 95% confidence interval (CI), 0.95-26.69; < 0.04) and requirement of mechanical ventilation (OR, 9.17; 95% CI, 1.01-83.10; < 0.02) were associated with mortality.
Acute PD in critically ill children with renal impairment is a lifesaving procedure. Treatment of shock with resuscitative measures and respiratory failure with mechanical ventilation, along with PD, resulted in favorable renal outcome.
腹膜透析（PD）在肾功能受损的儿童中是一种易于获得且简单的救命程序。在休克和需要机械通气的危重儿童中，PD 的疗效报告很少。
在这项前瞻性观察研究中，我们评估了印度一家三级教学医院儿科重症监护病房 50 名年龄在 1 个月至 14 岁的危重儿童的 PD 疗效和结局。
PD 的适应证为急性肾损伤（AKI），占 66%，其次是因感染并发症导致的慢性肾脏病急性恶化，占 34%。细菌性败血症是 AKI 的最常见原因（22%），其次是疟疾（14%）和重症登革热（12%）。开始 PD 时，26%的患者休克，46%的患者机械通气。PD 有效，pH 值、碳酸氢盐和乳酸水平在数小时内开始改善，肾小球滤过率估计值在 24 小时内持续改善，直至程序结束，包括休克和机械通气患者亚组。总并发症发生率为 14%，其中腹膜炎发生率为 4.0%。死亡率为 14%（7/50）。PD 开始时的休克（比值比（OR），5.03；95%置信区间（CI），0.95-26.69；<0.04）和机械通气的需求（OR，9.17；95% CI，1.01-83.10；<0.02）与死亡率相关。
急性 PD 在肾功能受损的危重儿童中是一种救命程序。通过复苏措施治疗休克，通过机械通气治疗呼吸衰竭，并联合 PD，可获得良好的肾脏结局。
