Re-evaluating criteria for peritoneal dialysis in "classical" (D+) hemolytic uremic syndrome

Background: Indications for peritoneal dialysis in children with post-dysen teric hemolytic uremic syndrome (D+ HUS) have not been thoroughly evaluated . Although early institution of dialysis may reduce mortality, the procedur e has attendant complications. Aim: To determine whether the use of more st ringent criteria for instituting dialysis had a better outcome to that of u sing conventional criteria. Method: Following an outbreak of Shigella dysen teriae type I D+ HUS in KwaZulu/Natal during June 1994 to October 1995, we compared the renal outcome and mortality between two periods: before May 19 95 (69 children) when conventional criteria for dialysis were employed and after May 1995 (70 children) when more stringent criteria for dialysis were applied. Results: The mean age of presentation was 35 months, 79 (56.8%) w ere males. Both groups were comparable except for gut perforation, which wa s more frequent before May 1995, and hypertension and severe disease, which were more frequent after May 1995. Seventy patients underwent dialysis, 36 (52.2%) before May 1995. There were no significant differences in renal ou tcome or death following discharge from hospital in both groups. Overall mo rtality was 20.1%, 15 (53.6%) of the 28 children that demised presented bef ore May 1995. Outcome: Accordingly, although children with more severe dise ase and a higher frequency of hypertension presented after May 1995, there were no significant differences in morbidity or mortality in those using st ringent criteria for dialysis, compared to those in whom conventional crite ria were used. Conclusion: We showed that several children, who would previ ously have been dialyzed, may be managed conservatively, without an increas e in mortality or morbidity.