Indications and Outcome of Different Dialysis Modalities in Critically Ill Children.

Document Type : Original Article

Authors

1 Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.

2 Department of Pediatrics, Shebin El Kanater Hospital, Cairo, Egypt.

Abstract

Introduction: Dialysis is one of therapeutic interventions used for critically ill children .Dialysis modalities include peritoneal dialysis (PD), intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT).
Aim of the study: is to describe the use of different dialysis modalities in pediatric intensive care units (PICUs) regarding their indications and outcome. 
Methods: The prospective descriptive study included all patients admitted to PICUs over a period of six months from November 2017 to April 2018, we obtained the indications of dialysis, type of dialysis modality received, dialysis prescription, and outcome.
Results: Out of 977 patients admitted to the PICU during the study period, 44 patients (4.5%) required dialysis. Peritoneal dialysis  was the most common dialysis modality used in this study (72.8%, n=32/44), CRRT was done for six patients (13.6%), and IHD was done for six patients (13.6%).The main indications of dialysis in the study group were azotemia in 25 cases (56.8%) PD was significantly less successful than IHD (p-value: 0.023), but there was no significant difference in success of CRRT over PD or IHD. The total mortality rate was (40.9% n=18), it was the highest with PD (94.4%, n= 17) and no mortality in IHD group during patients´ stay in the PICU. 
Conclusion: PD is the most commonly used dialysis modality in the PICU, but it has poor outcome. CRRT can improve outcome but it may be underutilized, because of the cost and the experience required. IHD is very successful in critically ill-children especially who were previously on regular HD. 

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