Introduction:
Dialysis can be life saving for acute kidney injury (AKI). Recent technological developments allow for dialysis in even small neonates, yet there is poor access for less resourced countries.
Objective:
Describing the profile of paediatric AKI needing dialysis, methods of dialysis, and outcomes of acute dialysis over 20 years.
Methods:
Retrospective review of children 0–18 years dialysed acutely at Red Cross War Memorial Children’s Hospital (RCWMCH), Cape Town, South Africa from 1998-2020.
Results:
Overall, 593 children with AKI received dialysis of which 463 (78.1%) children received PD. Their median age was 8.0 (range 0.03 to 219.3; IQR1.0–58.3) months; 57.6% were <1 year old. Patients’ weights ranged from 0.9–62.0 kg (median 7.0 kg, IQR 3.0–16.0 kg); 38.6% were <5 kg. Peritoneal dialysis (PD) was used in younger children (median 6.4 months) and extracorporeal dialysis (ECD) in older children (median 71.7 months, p=0.001) with bed-side catheter insertions (n=490/578, 84.8%) predominantly by paediatricians and nephrology fellows (n=412/490, 84.1%) rather than surgeons (78/490, 15.9%). Complications occurred in 127/560 (22.7%) children receiving PD. Overall, 314/542 (57.8%) children survived. Survival was significantly lower in neonates (<1 month old, 47.5%) and infants (<1 year old, 49.2%) compared to older children (>1 year old, 70.4%, p<0.0001). Survival was better in the ECD (75.4%) than in the PD group (55.6%, p=0.002).
Conclusion:
We demonstrate an acceptable survival in children with AKI requiring dialysis throughout the study period. Outcomes were poorer in smaller children. Acute PD, with bed-side catheter placement placed by non-surgeons, is a feasible, practical and acceptable dialysis modality in our setting.