Epidemiologic Study of Children on Continuous Ambulatory Peritoneal Dialysis in three Children's Hospitals(Ali Asghar, Mofid, Markaz Tebi) from 1993 to 2004

Infants suffering from chronic renal failure should be treated by peritoneal dialysis, hemodialysis or renal transplantation. Unfortunately, the last two modalities are fraught with too many technical difficulties to be used in very young infants. Therefore, until proper weight and age are achieved, prescribing CAPD(Continuous Ambulatory Peritoneal Dialysis) will be mandatory. Providing national registry in many countries has helped to improve the quality of care provided for the patients on CAPD. For this reason we decided to do a multicentral epidemiological study of Iranian children on CAPD. Patients and The records of children on CAPD referred to three main dialysis centers(Ali Asghar, Markaz Tebi, and Mofid Children's Hospitals) from 1993 to 2004 were collected and reviewed retrospectively. The incidence rate of peritonitis and patient's survival rate were determined. T-test, Chi-Square, and Kaplan Mayer were used to compare means, frequency and survival respectively. Cox regression was applied to determine factors influencing survival and correlation coefficient was calculated to reveal the relation between variables. P<0.05 was considered significant. Between 1993 and 2004, 57 children(27 females, 30 males) with a mean age of 32.3 months(ranging from 0.08 to 156 months) were on CAPD. The etiologies of renal failure were hereditary(10.5%), cystic(22.8%), glomerulopathy(33.2%), uropathy(14.3%), dysplasia(8.7%), and miscellaneous or unknown(10.5%). 99 Tenckhoff catheters were inserted surgically. The most frequent surgical complications were hernia and leakage. Peritonitis rate was 1:4.85 patient's months. The rate of peritonitis was higher in children under 12 months, those with Tenckhoff catheters, and children with a low weight and BMI(Body Mass Index) at the start of CAPD(P=0.01). The results of peritoneal fluid cultures were as follows: gram positive(32%), gram negative(28%), negative(30%), and fungi(10%). There was a significant correlation between fungal peritonitis and peritonitis rate and the first episode of peritonitis(P=0.01). The mean of patient's survival rate was 0.9 years(95% CI 0.61-1.16). The outcomes of children were recovery(10.5%), transplantation(8.8%), switch to hemodialysis(7%), still on CAPD(14%), death(57.9%), and 1.8% were missed out. Due to the high rate of mortality and morbidity in children on CAPD, we recommend tighter nutritional control, periodical re-education to parents, and expert medical staff to improve the prognosis.