Assesment of Early Surgical Complications of Peritoneal Dialysis Catheters for Acute Kidney Injury in Children at Kenyatta National Hospital.

Abstract

Background Peritoneal dialysis is a commonly deployed renal replacement therapy (RRT) option in children who have acute kidney injury (AKI) in many centers worldwide including Kenyatta National Hospital (KNH). Special catheters which are placed using various surgical techniques are used in peritoneal dialysis. The catheters may sometimes be associated with increased rates of infection and flow disturbances, probably related to the technique and type of catheter used hence the need to establish the rate of these complications and any impact of these different catheter types or techniques on the outcomes as seen at KNH. Objective This study aims to assess the rate of early surgical complications during peritoneal dialysis in children who have acute kidney injury. Materials and methods This was a prospective descriptive study carried out in KNH pediatrics wards and the paediatric specialized unit over a period of six months. All pediatric patients with AKI requiring PD were entered into the study .Data on type of PD catheter used, technique of insertion of the PD catheter, and complications were entered into a questionnaire and analyzed by Analysis was done using Software for statistical analysis STATA version 11.0. Summary data were produced to report characteristics of participants using simple frequencies. Continuous variables were represented using degrees of central tendency such as means and medians with interquartile ranges (IQR).The data is presented in forms of tables, pie charts and bar charts. Results The average age of the study population was twelve days with interquartile range of nine days to three years with a slight male preponderance (51.69%). All the patients received prophylactic antibiotics before PD catheter insertion. These catheters were fixed by general surgery or paediatric surgery residents using the open method only. The procedures were done in theatre where different kinds of anaesthesia were employed. There were neither visceral injuries nor excessive bleeding during the insertion process. The majority of the catheters were single cuffed (70.97%) and tunneling of these catheters was done in 93.55%. Omentectomy was rarely done (16.13%).Mechanical PD failure (outflow obstruction and pericatheter leakage) was seen in 35.48% while infectious complications (exit site infection and peritonitis) were seen in 45.16 %. During the two week follow up period 87.10% had resolution of AKI, 6.45% progressed to CKD while another 6.45% succumbed to their illness. Conclusion Peritoneal dialysis is commonly employed in children for management of AKI. The open method is used for insertion and little complication is encountered during the process. However mechanical and infectious complications are fairly common. Most of the patients do well following peritoneal dialysis.