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. 2024 Sep;39(9):2807-2818.
doi: 10.1007/s00467-024-06399-1. Epub 2024 May 11.

Dialysis for paediatric acute kidney injury in Cape Town, South Africa

Mignon I McCulloch  1   2 , Valerie A Luyckx  3 , Brenda Morrow  3 , Peter Nourse  4   3 , Ashton Coetzee  4   3 , Deveshni Reddy  4   3 , Christel Du Buisson  5 , Jonathan Buckley  4   3 , Ilana Webber  3 , Alp Numanoglu  3 , Gina Sinclair  4   3 , Candice Nelson  4   3 , Shamiel Salie  4   3 , Kirsten Reichmuth  3 , Andrew C Argent  3
Affiliations

Dialysis for paediatric acute kidney injury in Cape Town, South Africa

Mignon I McCulloch et al. Pediatr Nephrol. 2024 Sep.

Erratum in

  • Correction: Dialysis for paediatric acute kidney injury in Cape Town, South Africa.
    McCulloch MI, Luyckx VA, Morrow B, Nourse P, Coetzee A, Reddy D, Du Buisson C, Buckley J, Webber I, Numanoglu A, Sinclair G, Nelson C, Salie S, Reichmuth K, Argent AC. McCulloch MI, et al. Pediatr Nephrol. 2025 Dec;40(12):3843. doi: 10.1007/s00467-025-06880-5. Pediatr Nephrol. 2025. PMID: 40924184 Free PMC article. No abstract available.

Abstract

Background: Dialysis is lifesaving for acute kidney injury (AKI), but access is poor in less resourced settings. A "peritoneal dialysis (PD) first" policy for paediatric AKI is more feasible than haemodialysis in low-resource settings.

Methods: Retrospective review of modalities and outcomes of children dialysed acutely at Red Cross War Memorial Children's Hospital between 1998 and 2020.

Results: Of the 593 children with AKI who received dialysis, 463 (78.1%) received PD first. Median age was 9.0 (range 0.03-219.3; IQR 13.0-69.6) months; 57.6% were < 1 year old. Weights ranged from 0.9 to 2.0 kg (median 7.0 kg, IQR 3.0-16.0 kg); 38.6% were < 5 kg. PD was used more in younger children compared to extracorporeal dialysis (ECD), with median ages 6.4 (IQR 0.9-30.4) vs. 73.9 (IQR 17.5-113.9) months, respectively (p = 0.001). PD was performed with Seldinger soft catheters (n = 480/578, 83%), predominantly inserted by paediatricians at the bedside (n = 412/490, 84.1%). 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 (1-12 months old, 49.2%) compared with older children (> 1 year old, 70.4%, p < 0.0001). Survival was superior in the ECD (75.4%) than in the PD group (55.6%, p = 0.002).

Conclusions: "PD First for Paediatric AKI" is a valuable therapeutic approach for children with AKI. It is feasible in low-resourced settings where bedside PD catheter insertion can be safely taught and is an acceptable dialysis modality, especially in settings where children with AKI would otherwise not survive.

Keywords: Acute kidney injury; Child; Extracorporeal dialysis; Neonate: Infant; Peritoneal dialysis.

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Conflict of interest statement

None.

Figures

None
A higher resolution version of the Graphical abstract is available as Supplementary information
See this image and copyright information in PMC

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