Peritoneal Dialysis International, Vol. 21, pp. 390–394 Printed in Canada. All rights reserved. 0896-8608/01 $3.00 + .00 Copyright © 2001 International Society for Peritoneal Dialysis 390 PERITONEAL DIALYSIS FOR MANAGEMENT OF PEDIATRIC ACUTE RENAL FAILURE Joseph T. Flynn, David B. Kershaw, William E. Smoyer, Patrick D. Brophy, Kevin D. McBryde, and Timothy E. Bunchman 1 Division of Pediatric Nephrology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan; Division of Pediatric Nephrology, 1 University of Alabama at Birmingham, Birmingham, Alabama, U.S.A. Correspondence to: J.T. Flynn, Pediatric Nephrology, Montefiore Medical Center, 111 East 210th Street, Bronx, New York 10467 U.S.A. jflynn@montefiore.org Received 7 November 2000; accepted 7 March 2001. ¨ Background: While the use of continuous renal replace- ment therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment of pediatric ARF has received less attention. ¨ Design: Retrospective database review of children re- quiring PD for ARF over a 10-year period. ¨ Setting: Pediatric intensive care unit at a tertiary-care referral center. ¨ Patients: Sixty-three children without previously known underlying renal disease who required PD for treatment of ARF. ¨ Results: Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 ± 13 days. Children with ARF were younger (30 ± 48 months vs 88 ± 68 months old, p < 0.0001) and smaller (11.9 ± 15.9 kg vs 28 ± 22 kg, p < 0.0001) than children with known underlying renal dis- ease who began PD during the same time period. Percu- taneously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was com- mon in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. Recovery of renal function occurred in 38% of patients; patient survival was 51%. ¨ Conclusions: Peritoneal dialysis remains an appropri- ate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal re- placement therapies. KEY WORDS: Children; acute renal failure. O ver the past decade, the treatment of acute renal failure (ARF) in children has been trans- formed by the development of continuous renal re- placement therapies (CRRT), such as continuous hemofiltration and continuous hemodiafiltration (1,2). Although these therapies have certain advantages, particularly in patients who are hemodynamically unstable or who have multiorgan failure (2,3), they are technology- and labor-intensive and may not be necessary in many children with ARF. Peritoneal di- alysis (PD), on the other hand, is a much simpler tech- nique (4) that can be utilized in many clinical settings, particularly in countries or institutions lacking the resources needed to provide CRRT (5–9). To gain a better appreciation of the role that PD may play in the CRRT era, we reviewed our experience with PD in the treatment of ARF over a 10-year period. MATERIALS AND METHODS MATERIALS AND METHODS MATERIALS AND METHODS MATERIALS AND METHODS MATERIALS AND METHODS DATA COLLECTION Since 1989, the Division of Pediatric Nephrology at the University of Michigan Medical Center has maintained a database of all children requiring renal replacement therapy (RRT) for renal failure. Mainte- nance of this database is approved annually by the Medical Center’s Institutional Review Board. Patients requiring dialysis for renal failure are identified and then entered into the database following hospital dis- charge. Using a standardized data collection form, research personnel collect data regarding age, weight, blood pressure and vasopressor use, cause of renal failure, dialysis modality and type of access utilized, length of time on dialysis, complications of dialysis, patient survival, and recovery of renal function. Labo- ratory data and data regarding fluid clearance are not routinely collected. Data are then entered into a computer database (Microsoft Excel 97, Microsoft Cor- poration, Redmond, Washington, U.S.A.). by guest on November 23, 2015 http://www.pdiconnect.com/ Downloaded from