Pediatric peritoneal dialysis in Korea: Practical solutions to the problems of peritoneal dialysis for children

Purpose:To find and solve the common problems of peritoneal dialysis (PD) b y analyzing the clinical data of pediatric PD performed in Korea. Methods:We looked at 264 cases of continuous ambulatory peritoneal dialysis (CAPD) and acute PD that were performed in 18 institutions of pediatric ne phrology in Korea from November 1987 to October 1997. Results: CAPD was performed in 114 cases.The mean age of the patients was 1 0.5 +/- 6.6 years, and the male-to-female ratio was 1.4:1.The original caus es of end-stage renal disease (ESRD) were proven in 92 cases (81%). The mos t common renal diseases were focal segmental glomerulosclerosis (17%), refl ux nephropathy (11%), and chronic glomerulonephritis (11%). Mean duration o f CAPD was 20 months +/- 16.9 months. Peritonitis was the most common compl ication, and the peritonitis incidence was 0.96 episode per patient-year. O ther complications were exit-site infection in 10 cases, obstruction in 7 c ases, and leakage of dialysate in 6 cases. The most common etiologic organi sm of peritonitis was Staphylococcus aureos and the next most common was co agulase-negative staphylococcus. Acute PD was performed in 150 cases. The m ost common underlying causes were congenital heart disease, hemolytic uremi c syndrome, sepsis, and dehydration. The mean duration was 10.3 +/- 11.3 da ys. The most common complication was peritonitis (78.3%). The most common e tiologic organisms of peritonitis were Staphylococcus aureus, coag-neg stap hylococcus, Acinetobacter, and Pseudomonas. Conclusion: Reflux nephropathy should be emphasized in early diagnosis and treatment to prevent ESRD. Incidence of congenital anomaly (7%) as a origin al cause of ESRD was relatively low in Korea. Growth status was not signifi cantly improved after CAPD. In acute PD, the incidence of peritonitis rapid ly increased at 2 weeks after the start of dialysis.