Acute kidney injury (AKI) is a common complication in pediatric and neonatal intensive care units (ICU). Renal replacement therapy (RRT) is frequently needed in children in whom supportive therapy is not enough to satisfy their metabolic demands or to be able to provide adequate nutrition. The decision to begin dialysis should not be delayed since experience in infants shows that the shorter the time from the insult to the beginning of dialysis, the higher the survival rate. As the use of continuous RRT in pediatric patients in the ICU has almost tripled, the use of peritoneal dialysis (PD) and intermittent hemodialysis has markedly decreased. The patient’s age seems to be the most important factor influencing the decision on the choice of dialysis modality. PD is still the most common modality used in patients younger than 6 years of age. The relatively low cost, technical simplicity, no need for anticoagulation or placement of central venous catheters, and excellent tolerance in hemodynamically unstable patients are among the most significant advantages of PD. Much controversy exists regarding the adequacy of PD in hypercatabolic patients in the ICU. Nonetheless, when Kt/V has been applied to acutely ill children, it has been shown that PD can provide adequate clearances for most infants. The outcomes of critically ill patients with AKI treated with PD are comparable to other dialysis modalities. Therefore, the decision about dialysis modality should be based on local expertise, resources available, and patient’s clinical status.

Keywords:
Peritoneal dialysis, Intensive care unit, Acute kidney injury, Children, Infants
1.
Williams DM, Sreedar SS, Mickell JJ, Chan JCM: Acute kidney failure: a pediatric experience over 20 years. Arch Pediatr Adolesc Med 2002;156:893–900.
2.
Mishra OP, Gupta AK, Pooniya V, Prasad R, Tiwary NK, Schaefer F: Peritoneal dialysis in children with acute kidney injury: a developing country experience. Perit Dial Int 2012;32:431–436.
3.
Hui-Stickle S, Brewer ED, Goldstein SL: Pediatric ARF epidemiology at a tertiary care center from 1999 to 2001. Am J Kidney Dis 2005;45:96–101.
4.
Zappitelli M, Bernier PL, Saczkowski RS, Tchervenkov CI, Gottesman R, Dancea A, Hyder A, Alkandari O: A small post-operative rise in serum creatinine predicts acute kidney injury in children undergoing cardiac surgery. Kidney Int 2009;76:885–892.
5.
Samuels J, Ng CS, Nates J, Price K, Finkel K, Salahudeen A, Shaw A: Small increases in serum creatinine are associated with prolonged ICU stay and increased hospital mortality in critically ill patients with cancer. Support Care Cancer 2011;19:1527–1532.
6.
Mammen C, Abbas AA, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG: Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 2012;59:523–530.
7.
Sorof JM, Stromberg D, Brewer ED, Feltes TF, Fraser CD Jr: Early initiation of peritoneal dialysis after surgical repair of congenital heart disease. Pediatr Nephrol 1999;13:641–645.
8.
Bojan M, Gioanni S, Vouhé PR, Journois D, Pouard P: Early initiation of peritoneal dialysis in neonates and infants with acute kidney injury following cardiac surgery is associated with a significant decrease in mortality. Kidney Int 2012;82:474–481.
9.
Sutherland SM, Zappitelli M, Alexander SR, Chua AN, Brophy PD, Bunchman TE, Hackbarth R, Somers MJ, Baum M, Symons JM, Flores FX, Benfield M, Askenazi D, Chand D, Fortenberry JD, Mahan JD, McBryde K, Blowey D, Goldstein SL: Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis 2010;55:316–325.
10.
Warady BA, Bunchman T: Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 2000;15:11–13.
11.
Flynn JT: Choice of dialysis modality for management of pediatric acute renal failure. Pediatr Nephrol 2002;17:61–69.
12.
Chadha V, Warady BA, Blowey DL, Simckes AM, Alon US: Tenckhoff catheters prove superior to cook catheters in pediatric acute peritoneal dialysis. Am J Kidney Dis 2000;35:1111–1116.
13.
Auron A, Warady BA, Simon S, Blowey DL, Srivastava T, Musharaf G, Alon US: Use of the multipurpose drainage catheter for the provision of acute peritoneal dialysis in infants and children. Am J Kidney Dis 2007;49:650–655.
14.
Golej J, Kitzmueller E, Hermon M, Boigner H, Burda G, Trittenwein G: Low-volume peritoneal dialysis in 116 neonatal and paediatric critical care patients. Eur J Pediatr 2002;161:385–389.
15.
Alarabi AA, Petersson T, Danielson BG, Wikström B: Continuous peritoneal dialysis in children with acute renal failure. Adv Perit Dial 1994;10:289–293.
16.
Korbet S: Acute peritoneal dialysis prescription; in Daugirdas PB, Ing TS (eds): Handbook of Dialysis. Philadelphia, Lippincott Williams & Wilkins, 2007, p 382.
17.
McNiece KL, Ellis EE, Drummond-Webb JJ, Fontenot EE, O’Grady CM, Blaszak RT: Adequacy of peritoneal dialysis in children following cardiopulmonary bypass surgery. Pediatr Nephrol 2005;20:972–976.
18.
Chitalia V, Almeida AF, Rai H, Bapat M, Chitalia KV, Acharya VN, Khanna R: Is peritoneal dialysis adequate for hypercatabolic acute renal failure in developing countries? Kidney Int 2002;61:747–757.
19.
George J, Varma S, Kumar S, Thomas J, Gopi S, Pisharody R: Comparing continuous venovenous hemodiafiltraiton and peritoneal dialysis in critically ill patients with acute kidney injury: a pilot study. Perit Dial Int 2011;31:422–429.
20.
Carter M, Kilonzo K, Odiit A, Kalyesubula R, Kotanko P, Levin N, Callegari J: Acute peritoneal dialysis treatment programs for countries of the East African community. Blood Purif 2012;33:149–152.
© 2013 S. Karger AG, Basel
2013
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