EFFICACY AND SAFETY OF USING NON-TUNNELED HEMODIALYSIS CATHETERS FOR URGENT PERITONEAL DIALYSIS IN PEDIATRIC PATIENTS WITH ACUTE KIDNEY INJURY: PILOT CASE SERIES STUDY

Children with KDIGO stage 3 acute kidney injury (AKI) face a high risk of mortality without immediate dialysis access. While nearly 60% of the world's children live in low- and middle-income countries. These are the exact settings that most urgently need peritoneal dialysis (PD), which is crucial for AKI management. In Egypt, the frequent unavailability of standard Tenckhoff-PD catheters restricts their consistent use, often resulting in delayed or limited treatment for patients. In such situations, the off-label use of non-tunneled hemodialysis catheters inserted into the peritoneal cavity under ultrasound guidance to perform PD was an alternative way. Despite its promising applicability, the safety and efficacy of this technique remain underreported. This pilot study aimed to evaluate the clinical outcomes, technical feasibility, and complication rates associated with this approach in a pediatric nephrology unit in a low-resource environment.

This case series cohort was conducted at Mansoura University Pediatric Hospital between April and September 2025. It included 11 pediatric patients with AKI who required peritoneal dialysis but had no access to appropriately sized PD catheters. A non-tunneled HD catheter was inserted into the peritoneal cavity using sterile technique under ultrasound guidance (figure1). Urgent PD started, with number of sessions depending on patient’s needs. Patients were monitored for technical success, dialysis duration, complications, urine output recovery, and overall outcomes.

The study included 11 children (7 females, 4 males) with a mean age of 19.5 months and a mean body weight of 9.0 ± 1.6 kg. Anuria was present in 90% of cases at initiation. The primary causes of AKI were diarrhea-associated hemolytic uremic syndrome (55%), sepsis (36%), and maple syrup disease (9%). Initial Technical success in catheter placement was achieved in 100% of patients. The mean duration of catheter use was 10.9 days (range: 3 to 30 days). Improvement in urine output was noted in 7 patients (64%), with a median time to recovery of 8 days. Complete resolution of AKI was achieved in 6 patients (54%), all of whom survived and were discharged. The remaining 5 patients (46%) did not recover kidney function and died, primarily due to the original sepsis-related complications.

Complications related to the procedure were observed in one patient (9%): one case of vascular injury discovered two days after kidney recovery and catheter removal, injury to inferior epigastric vs was presumed to be the cause. Two cases of catheter blockage were reported and need catheter exchange (HD catheter has small pores easy to be blocked), no reported cases of leakage, or mechanical malfunction. Peritonitis was reported in one case.

Inserting non-tunneled HD catheters for PD in low-weight pediatric patients with AKI is a technically feasible, safe, and potentially life-saving alternative when conventional PD catheters are unavailable. These findings suggest that This approach may help bridge critical care gaps where pediatric PD equipment is lacking. Warrants further research with larger sample sizes to better assess outcomes and optimize safety.