PERITONEAL-DIALYSIS IN CHILDREN UNDER 5 YEARS OF AGE

Objective: We report our experience with maintenance peritoneal dialys is (PD) in small children. Design: This is a retrospective analysis of the patient records of ail children under the age of 5 years treated with continuous peritoneal dialysis (CPD) between 1986 and 1994 in Fin land. Setting: Treatment was started and the patients were seen at the outpatient clinic at the Hospital for Children and Adolescents, Unive rsity of Helsinki, every 3 months. Between these visits, they had cont rols at their local hospital every 2 - 4 weeks. Patients: The most com mon primary renal disease in these 34 patients was congenital nephroti c syndrome of the Finnish type (27 patients). Others were: congenital nephrotic syndrome (3 patients), polycystic kidney disease (I), urethr al valve (I), neuroblastoma (1), and renal dysplasia (1). Results: Mea n age at onset was 1.6 years and median treatment time 9.3 months. Tim e spent in hospital decreased from 270 days/year in the 1980s to 150 d ays/year in the 1990s. Two children died (5.9%). The peritonitis rate on continuous cyclic peritoneal dialysis was 1:11.5 patient-months. He rnias were diagnosed in 29% of the patients. After 3 months half of th e patients were on antihypertensive medication. Pulmonary edema was di agnosed once in 12 patients and twice in 2 patients. During the first 6 months on PD the mean height standard deviation score (hSDS) increas ed from -2.13 to -1.65 (p < 0.0001). The B-month change in hSDS before initiation and 6 months after the start of CPD increased from -0.12 /- 0.68 to +0.59 +/- 0.64 (p = 0.0008). Conclusions: Our results indic ate that peritoneal dialysis Is feasible and safe in small children. M ortality was low and growth was good. The major challenges presented b y CPD therapy were maintenance of optimal nutrition, avoidance of peri tonitis, and control of volemia.