Children with hypoalbuminemia on continuous peritoneal dialysis are at risk for technique failure

Background. Few data are available on the clinical significance of hypoalbu minemia [serum albumin (SA) <35 g/L] in children with end-stage renal disea se (ESRD) on continuous peritoneal dialysis (CPD). This study was conducted to analyze the prevalence of hypoalbuminemia, its predictive factors, and its clinical impact in these children. Methods. A retrospective analysis was done of 180 patients on CPD over the last 22 years. Patients were excluded from the study if they were on CPD fo r less than four months or had nephrotic syndrome. Demographic, clinical, a nd biochemical variables were studied. Children continued on CPD until they received a transplant or were transferred to an adult unit or to hemodialy sis as a result of technique failure. The subjects were divided into two gr oups based on SA levels at last follow-up. Results. A total of 135 children was included. After a mean duration of CPD of 573 +/- 437 (120 to 2960) days, 54 children (40%) were observed to have hypoalbuminemia. Four patients (2.9%) died, 7 (5.2%) continued on continuo us cyclic peritoneal dialysis, and 13 (9.6%) were transferred to an adult u nit for continuation of CPD. Ninety-five (70.3%) were transplanted, and 16 (11.8%) were transferred to hemodialysis because of technique failure. Chil dren in group I (N = 54, SA <35 g/L), compared with group II (N = 81, SA gr eater than or equal to 35 g/L), were younger at initiation of PD, more like ly to have hypoalbuminemia at one month and six months after initiation of PD, and have more episodes of peritonitis. No differences were seen between the groups in gender, modality of CPD, body surface area, initial body mas s index, and presence of hypertension or acidosis. The only factors predict ive of hypoalbuminemia on follow-up were low SA at one month after PD and r ecurrent peritonitis using multiple logistic regression analysis. Evaluatin g the clinical impact of hypoalbuminemia, we observed a higher incidence of failed PD in children who had hypoalbuminemia. Conclusion. Low SA at one month after PD and recurrent peritonitis are pred ictive of hypoalbuminemia in children on CPD, which is associated with an i ncreased incidence of CPD failure.