Peritoneal dialysis in children with sepsis-associated AKI (SA-AKI): an experience in a low- to middle-income country.

IF 1.4 4区 医学 Q3 PEDIATRICS Paediatrics and International Child Health Pub Date : 2021-05-01 Epub Date: 2021-01-17 DOI:10.1080/20469047.2021.1874201
Apurva Tomar, Virendra Kumar, Abhijeet Saha
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引用次数: 10

Abstract

Background: In critically ill children, sepsis-associated acute kidney injury (SA-AKI) has significant morbidity and mortality.Aim: To estimate whether early initiation of peritoneal dialysis (PD) has a better short-term outcome than standard PD.Methods: Early PD (n = 25) was defined as a need for PD in Kidney Disease: Improving Global Outcomes (KDIGO) stage 2 AKI, while those fulfilling the criteria for stage 3 KDIGO were categorised as a standard PD group (n = 25). The primary outcome measure was the estimated glomerular filtration rate (eGFR) at discharge or at 4 weeks after initiation of PD, whichever occurred earlier.Results: A prospective cohort of 50 children (32 boys) aged 2 months to 16 years with SA-AKI who underwent PD were recruited. The most frequent indication for PD was fluid overload (40%), followed by persistent metabolic acidosis (36%). Children in the early PD group had lower creatinine and higher eGFR at discharge/4-week follow-up (p < 0.001). The duration of PD was less if it was commenced early (p < 0.04); 24 of 25 (96%) children in the early PD group were off PD within 6 days of initiation compared with 13 of 25 (52%) in the standard PD group (p < 0.001).Conclusions: Compared with standard PD, early PD in SA-AKI resulted in a favourable renal outcome, decreased duration of PD and early discontinuation of dialysis.Abbreviations : AKI: acute kidney injury; CRRT: continuous renal replacement therapy; CS-AKI: cardiac surgery-associated acute kidney injury; eGFR: estimated glomerular filtration rate; ELAIN: early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury; ESCAPE: effect of strict blood pressure control and ACE inhibition on the progression of chronic kidney disease in paediatric patients; HIC: high-income countries; ISN: international society of nephrology; KDIGO: Kidney Disease: Improving Global Outcomes; LMIC: low- to middle-income countries; PD: peritoneal dialysis; PICU: paediatric intensive care unit; RRT: renal replacement therapy; SA-AKI: sepsis-associated acute kidney injury; SYL: Saving Young Lives; SOFA: sequential (sepsis-related) organ failure assessment score; STARRT-AKI: standard versus accelerated initiation of renal replacement therapy in acute kidney injury.

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腹膜透析治疗败血症相关性AKI (SA-AKI)儿童:中低收入国家的经验
背景:在危重儿童中,败血症相关急性肾损伤(SA-AKI)具有显著的发病率和死亡率。目的:评估早期开始腹膜透析(PD)是否比标准PD有更好的短期预后。方法:早期PD (n = 25)被定义为需要PD治疗肾脏疾病:改善总体结局(KDIGO) 2期AKI,而满足KDIGO 3期标准的患者被归类为标准PD组(n = 25)。主要结局指标是出院时或PD开始后4周估计的肾小球滤过率(eGFR),以较早者为准。结果:招募了50名2个月至16岁的SA-AKI儿童(32名男孩),他们接受了PD治疗。PD最常见的适应症是体液超载(40%),其次是持续性代谢性酸中毒(36%)。早期PD组患儿出院时肌酐较低,eGFR较高(p p p) /4周随访(p p p p)结论:与标准PD相比,SA-AKI早期PD患者的肾脏预后良好,PD持续时间缩短,且早期停止透析。AKI:急性肾损伤;CRRT:持续肾替代治疗;CS-AKI:心脏手术相关急性肾损伤;eGFR:估计肾小球滤过率;ELAIN:急性肾损伤危重患者早期与晚期肾替代治疗的比较ESCAPE:严格控制血压和抑制ACE对儿科慢性肾病进展的影响高收入国家:高收入国家;ISN:国际肾脏病学会;KDIGO:肾病:改善全球预后;中低收入国家:中低收入国家;PD:腹膜透析;PICU:儿科重症监护病房;RRT:肾脏替代疗法;SA-AKI:脓毒症相关急性肾损伤;SYL:拯救年轻生命;SOFA:序贯(败血症相关)器官衰竭评估评分;start - aki:急性肾损伤的标准与加速启动肾脏替代治疗。
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来源期刊
CiteScore
3.30
自引率
0.00%
发文量
19
审稿时长
6-12 weeks
期刊介绍: Paediatrics and International Child Health is an international forum for all aspects of paediatrics and child health in developing and low-income countries. The international, peer-reviewed papers cover a wide range of diseases in childhood and examine the social and cultural settings in which they occur. Although the main aim is to enable authors in developing and low-income countries to publish internationally, it also accepts relevant papers from industrialised countries. The journal is a key publication for all with an interest in paediatric health in low-resource settings.
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