Emergency peritoneal dialysis via haemodialysis catheter for paediatric acute kidney injury in low-income settings: a life-saving procedure.

BACKGROUND

The percutaneous insertion of a peritoneal dialysis (PD) catheter by a nephrologist offers a plausible alternative to surgical insertion, improving access to dialysis. We report the experience of the paediatric nephrology unit in Dakar, Senegal, initiating PD for children with acute kidney injury (AKI), using a haemodialysis catheter inserted via a modified Seldinger technique. This approach was chosen due to its availability and cost-free provision, addressing resource constraints effectively.

METHODS

This pilot case series study describes a cohort of nine children with AKI managed using this innovative technique between March and October 2024 in Dakar, Senegal.

RESULTS

Nine children, including two neonates with life-threatening AKI, were included. Mean age was 4.5 years, with a male-to-female ratio of 1.25. Infections accounted for 44.4% (n = 4) of the cases. Catheter insertion in the peritoneal cavity was successful in eight out of nine cases; one mispositioned catheter (case 9) was removed and excluded from analysis. During the first week, no cases of bleeding or dialysate leakage occurred at the insertion site. Peritonitis was observed in two cases after > 2 weeks. Of the eight children with successful catheter placement, five stabilised on PD (62.5%); and of those five, two (40%) fully recovered kidney function. Three children (37.5%) succumbed to septic shock from the underlying infection.

CONCLUSIONS

Within the "Saving Young Lives" programme, our small case series showed that a haemodialysis catheter can feasibly deliver paediatric emergency PD in Dakar. Safety, efficacy, and programme-level impact must be confirmed in larger, multi-centre studies before wider training and implementation.