Peritoneal dialysis for management of pediatric acute renal failure

Background. While the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the ro le of peritoneal dialysis (PD) in the treatment of pediatric ARF has receiv ed less attention. Design: Retrospective database review of children requiring PD for ARF over a 10-year period. Setting: Pediatric intensive care unit at a tertiary-care referral center. Patients: Sixty-three children without previously known underlying renal di sease who required PD for treatment of ARF Results: Causes of ARF were congestive heart failure (27), hemolytic-uremic syndrome (13), sepsis (10), nonrenal organ transplant (7), malignancy (3), and other (3). Mean duration of PD was 11 +/- 13 days. Children with ARF w ere younger (30 +/- 48 months vs 88 +/- 68 months old, p < 0.0001) and smal ler (11.9 +/- 15.9 kg vs 28 +/- 22 kg, p < 0.0001) than children with known underlying renal disease who began PD during the same time period. Percuta neously placed PD catheters were used in 62% of children with ARF, compared to 4% of children with known renal disease (p < 0.0001). Hypotension was c ommon in patients with ARF (46%), which correlated with a high frequency of vasopressor use (78%) at the time of initiation of PD. Complications of PD occurred in 25% of patients, the most common being catheter malfunction. R ecovery of renal function occurred in 38% of patients; patient survival was 51%. Conclusions: Peritoneal dialysis remains an appropriate therapy for pediatr ic ARF from many causes, even in severely ill children requiring vasopresso r support. Such children can be cared for without the use of more expensive and technology-dependent forms of renal replacement therapies.