Introduction:
Acute kidney injury (AKI) is associated with increased morbidity and mortality in children. In developing countries, many children die from AKI, mainly due to a lack of facilities for kidney replacement therapy (KRT). In a resource-limited setting, where standard catheters and fluids for peritoneal dialysis (PD) are not available, they can be improvised from locally available materials. The armed conflict in Tigray, northern Ethiopia, has lasted almost two years and has resulted in enormous damage to the health care system including dialysis service in the region. Six months into the war, the use of improvised PD was the only option left to save the lives of children in need of dialysis. This article briefly discusses two cases of first-ever successfully improvised PD in children with stage III AKI (due to post infectious glomerulonephritis) needing KRT in the war-torn Tigray region.
Methods:
Local anesthesia was given at the bedside using an aseptic technique, after which a small incision was made and the tube was inserted into the peritoneal cavity. Peritoneal dialysis (PD) was started using a modified nasogastric tube (with three extra side holes). A PD solution of 2.5% dextrose was prepared by adding 62 ml of 40% dextrose to 1 l Ringer lactate (as 50% dextrose is not available in our setting). A PD solution of 1.5% dextrose was made by adding 37 ml of 40% dextrose to 1 l Ringer lactate. Potassium (4 mmol/l) was added to the PD solution when serum potassium was less than 4 mmol/l. Heparin (500 IU/l) was added to all emergency and extemporaneous PD solutions. PD solution was made up by the attending nephrologist who did the best to work under sterile conditions, immediately before use. Exchanges were performed manually by the attending resident.
Results:
These two patients were successfully managed with acute PD using a modified nasogastric tube as a catheter and fortified Ringers lactate as a PD solution. Their improvement in renal function is illustrated in the image below.
Conclusions:
This showed that pediatric AKI requiring KRT may benefit from careful utilization of an improvised catheter and PD solutions in a resource-limited setting, especially at times of crisis including war
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.