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Dialysis for Paediatric Acute Kidney Injury in Cape Town, South Africa.

Article scientifique 2023 Anglais

Résumé

Abstract 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.

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McCulloch, M., Luyckx, V., Morrow, B., Nourse, P., Coetzee, A., Reddy, D., Buisson, C., Buckley, J., Webber, I., Numanoğlu, A., Sinclair, G., Nelson, C., Salie, S., Reichmuth, K., Argent, A. (2023). Dialysis for Paediatric Acute Kidney Injury in Cape Town, South Africa.. https://doi.org/10.21203/rs.3.rs-3408535/v1

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Auteur(s)

Mignon McCulloch Valérie A. Luyckx Brenda Morrow Peter Nourse Ashton Coetzee D.S. Reddy Christel Du Buisson Jonathan David Buckley Ilana Webber Alp Numanoğlu Gina Sinclair Candice J. Nelson Shamiel Salie Kirsten Reichmuth Andrew C. Argent

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