Challenges of peritoneal dialysis in the management of acute kidney injury in South-south Nigeria

Abstract

Background: Peritoneal dialysis (PD) remains a more practical modality for renal replacement therapy (RRT) in young children with Acute Kidney Injury (AKI) especially in resource poor settings. However, its utilization is limited by challenges such as low number of qualified health workers, cost of PD fluid and socio-demographic issues like poor housing, electricity and water supply.

Methods: In a retrospective study, the case notes of all children that had prescription for PD as a RRT for AKI over a 10-year period from February 2009 to March 2019 were reviewed. 

Results: Peritoneal dialysis was prescribed for 16 patients, 11 males and 5 females who were diagnosed with AKI. The main causes of AKI were gastroenteritis, malaria, sepsis and posterior urethral valve (PUV). The ages of these patients ranged from 3 days to 5 years (mean 3.00 + 1.59 years). However, PD was performed in 7 (44%) of these patients. Three (19%) patients had contraindications to PD such as peritonitis, recent abdominal surgery and intra-abdominal mass. Peritoneal Dialysis was performed manually with PD catheters inserted in the operating theatre by a paediatric surgeon. Size 16 urinary silicon catheter was used as an improvised PD catheter in 6 patients (86%). PD was delayed for more than 24 hours after prescription in all patients. Time before onset of PD ranged from 2 to 7 days with a mean time before PD as 1.78 ± 0.85 days. Duration of PD ranged from 2 hours to 10 days (mean 4.15 ± 1.00 days). Four (57%) of patients had full recovery of renal function while the remaining three (43%) patients died. All mortalities occurred within 48 hours of commencement of PD. The main challenges were unavailability of dialysis fluid in 100%, delay in obtaining parental consent for PD due to ignorance in 81% , financial constraint in 75% and cultural beliefs in 56% of patients.

Conclusion: The utilization of PD was found to be low in resource poor settings like ours. Contributory factors were financial constraints, non-availability of PD catheters and dialysis fluid, delay in obtaining parental consent and cultural beliefs.

Keywords: Acute Kidney Injury, Peritoneal dialysis, Challenges, poor resource setting.