Garg Manasi, V Lalitha A, Vasudevan Anil
Department of Pediatrics, Pondicherry Institute of Medical Sciences, Pondicherry, India.
Department of Pediatrics, Pediatric Intensive Care Unit, St. John's Medical College Hospital, Bengarulu, Karnataka, India.
J Pediatr Intensive Care. 2022 Jan 7;13(3):276-281. doi: 10.1055/s-0041-1741466. eCollection 2024 Sep.
Peritoneal dialysis (PD) is a simple and preferred modality of dialysis for children with acute kidney injury (AKI) in resource poor countries. The aim of the study is to evaluate the utility and safety of acute PD using rigid catheter in critically ill children admitted to pediatric intensive care unit (PICU) with emphasis on short-term patient and renal outcome and complications. In this retrospective study, outcome and complications of PD using rigid catheter were evaluated in 113 critically ill children admitted in PICU of a tertiary care hospital from 2014 to 2019. The most common causes for AKI were sepsis (39.8%), dengue infection (16.8%), and hemolytic uremic syndrome (13.2%). In 113 patients, 122 PD catheters were inserted, and the median duration of PD was 60 (IQR: 36-89) hours. At the initiation of PD, 64 (56.6%) patients were critically ill requiring mechanical ventilation and inotropes, 26 (23%) had disseminated intravascular coagulation, and 42 (37%) had multiorgan dysfunction syndrome. PD was effective and there was a significant improvement in urea and creatinine, and one-third patients ( = 38; 33.6%) had complete renal recovery at the end of PD. Total complications were seen in 67% children but majority of them were metabolic (39.8%). Total catheter related complications were seen in 21.2% and peritonitis was seen in 4.4%. Catheter removal due to complications was required in 8.8% children. Overall, among children on PD, 53.7% survived. Acute PD with rigid catheters can be performed bedside in absence of soft catheters and significant clearance can be obtained without major life-threatening complications.
腹膜透析（PD）是资源匮乏国家中急性肾损伤（AKI）患儿一种简单且首选的透析方式。本研究旨在评估在儿科重症监护病房（PICU）住院的危重症患儿中使用硬质导管进行急性PD的效用和安全性，重点关注短期患者情况、肾脏结局及并发症。在这项回顾性研究中，对2014年至2019年在一家三级医院PICU住院的113例危重症患儿使用硬质导管进行PD的结局和并发症进行了评估。AKI最常见的病因是脓毒症（39.8%）、登革热感染（16.8%）和溶血尿毒综合征（13.2%）。113例患者共插入122根PD导管，PD的中位持续时间为60（四分位间距：36 - 89）小时。开始PD时，64例（56.6%）患者病情危重，需要机械通气和使用血管活性药物，26例（23%）发生弥散性血管内凝血，42例（37%）发生多器官功能障碍综合征。PD是有效的，尿素和肌酐有显著改善，三分之一的患者（n = 38；33.6%）在PD结束时实现了完全肾脏恢复。67%的患儿出现了并发症，但大多数为代谢性并发症（39.8%）。导管相关并发症的总发生率为21.2%，腹膜炎的发生率为4.4%。8.8%的患儿因并发症需要拔除导管。总体而言，接受PD治疗的患儿中，53.7%存活。在没有软质导管的情况下，可在床边进行硬质导管急性PD，且能获得显著的清除效果，而无重大危及生命的并发症。
