Introduction:
Peritoneal dialysis is the dialysis modality of choice for children under 5 years of age with acute kidney injury but remains inaccessible in many low-resource settings due to lack of resources and training. Mortality for children with acute kidney injury is high and made worse when avoidable deaths occur due to absence in care.
Methods:
We aimed to describe the recent experience of the recently started acute peritoneal dialysis program at the Buea Regional Hospital, which at the time was the lone center offering peritoneal dialysis for children in Cameroon. This was a retrospective cross-sectional study covering the first 6 months of operations and included all children below 5 years seen at our hospital requiring peritoneal dialysis. The dialysis team consisted of an adult nephrologist trained via simulations in the context of the International Society of Nephrology Interventional Nephrology Fellowship Course, and nurses trained on site when cases presented to the facility.
Results:
13 patients were referred for peritoneal dialysis from different centers, out of which 7 children were received at the center. The others were presumed to have died. Among those who received peritoneal dialysis, most were females (n= 4; 57%). Median age (IQR) was 36 (10 – 60) months. Median serum creatinine (IQR) was 7.7 (5.7 – 9.8) mg/dL. Dialysis was carried out with a locally prepared solution comprising dextrose 50% and Ringers Lactate to achieve a 2.5% dialysate. Potassium Chloride and heparin were added as needed. A 40cm blunt tipped 6F nasogastric tube (NG) was used as peritoneal dialysis catheter via a guide-over-wire bedside placement approach. Side holes were added to the NG tube in sterile manner using a syringe needle heated over a burner. Holes were added to cover 50 to 60 percent of catheter length. A 3 way stopcock and 2 drip sets were connected to the NG tube to create and maintain a closed circuit throughout the course of dialysis. One case of catheter malfunction was recorded related to structural failure at the suction port of the NG tube, requiring change of catheter. No case of peritonitis was recorded. Overall, renal function returned to normal for 4 children (57.1%) while 3 children died, with 2 of them within the first 6 hours of starting PD.
Conclusions:
Locally adapted materials and solutions can offer a non-negligible survival opportunity for children needing peritoneal dialysis services in resource limited settings. There is need to build capacity of the nephrology community to offer peritoneal dialysis care using available resources where no other options exist.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.