OUTCOME OF IMPROVISED PERITONEAL DIALYSIS IN CHILDREN WITH ACUTE KIDNEY INJURY(AKI), AN EXPERIENCE OF RESOURCE LIMITED TERTIARY TEACHING HOSPITAL. ADDIS ABABA, ETHIOPIA

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OUTCOME OF IMPROVISED PERITONEAL DIALYSIS IN CHILDREN WITH ACUTE KIDNEY INJURY(AKI), AN EXPERIENCE OF RESOURCE LIMITED TERTIARY TEACHING HOSPITAL. ADDIS ABABA, ETHIOPIA

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Co-author 1

Betelhem Derese betelhemderese@gmail.com saint Peter's specialized hospital pediatrics Addis Ababa Ethiopia -

Co-author 2

Yemisrach Asfaw mekonnen.yemi@yahoo.com Saint Paul's Hospital Millennium Medical College pediatrics Addis Ababa Ethiopia *

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Introduction

Pediatric AKI is a common problem affecting all age groups. Dialysis intervention represents a corner stone in the management of sever form of AKI .The accessibility of newer extracorporeal blood purifying technologies in developed state is replacing peritoneal dialysis, but it is a main stay of RRT in children with resource limited centers. Hence, this study aims to analyze the outcome of improvised PD service in children with severe AKI in low income country.

Methods

A retrospective descriptive study was conducted in children admitted with the diagnosis of AKI and required peritoneal dialysis over a period of 3 years form ,July 2018 – Jan.2021,Addis Ababa, Ethiopia. Data were collected from the PICU and follow-up log book and patient charts using a structured data collection format which includes, sociodemographic data, renal disease information (at admission and on follow up); indication of dialysis, duration of dialysis session , complication and management outcome of dialysis at discharge and 3 month.

Results

14 children underwent peritoneal dialysis during the study period. A rigid PD catheter was inserted at the bedside by a pediatric nephrologist and PD fluid prepared by improvising Ringer lactate and 40 % dextrose. 11 of the kids were below the age of 5 years, 2 patients were in the age of 5 to 10 years and one child was 12 years old. The leading cause of AKI were acute glomerulonephritis(AGN) and hemolytic uremic syndrome(HUS) .uremia was the main indication for dialysis (92 %) followed by refractory fluid overload. The duration of peritoneal dialysis were 76.5±45 hours with range of 10-172 hours.5 patients developed PD peritonitis and one child had pre-catheter leak as a complication. Out of the 14 cases, 4 (28.5 %) patients fully recovered, 3 cases (21.4%) of them died, 1(7.2%) child developed CKD, 5 (35.7%) left against medical advice and 1 child (7.2%) lost from follow-up.

Conclusion

Improvised Peritoneal dialysis may be a successful solution for resource limited setups with its limitation of increased risk of PD peritonitis.

Kewords