ACUTE PERITONEAL DIALYSIS EXPERIENCE IN A PUBLIC TERTIARY HOSPITAL IN NIGERIA: CHALLENGES AND LIMITATIONS OF A RESOURCE POOR NATION

Abstract

Peritoneal Dialysis is a well-known treatment option for Acute Kidney Injury. It is believed to be less expensive and more frequently used in the developing countries. We report our experience in the practice of Peritoneal dialysis in a resource constrained environment and acknowledge that it is indeed a simple procedure. The challenges of availability of catheters have limited its widespread use and focused PD have evolved as our adaptation.

Method: Prospective study of children who had PD between October 2015 and December 2016 at the Lagos State University Teaching Hospital, Ikeja. Information such as Age, gender, cause of Acute kidney injury, indication for dialysis, duration, type of catheter used, complication and outcome were documented.

Result: A total number of 17 cases of AKI had peritoneal dialysis over a period of one year. Their age ranges between 10days to 12years with a mean age of 174.94±203.31 (in weeks). Fifty-three percent (9) of them were males while 47% (8) were females with male to female ratio of 1.1:1. Sepsis (52.9%) and primary kidney diseases (36.3%) were the most common causes of AKI requiring dialysis. Indications for dialysis include fluid overload (60.0%), severe metabolic acidosis (53%), anuria (40.0%), Hyperkalemia (40.0%) and oliguria (33.0%). Majority of them (14; 82.4%) had standard peritoneal dialysis fluid while 3(17.6%) had improvised concocted fluid using ringers lactate and 50% dextrose water. The duration of PD ranged between <1 to 16days with a mean duration of 7.31±4.61. Catheter blockage (17.6%), leakage and slip out (17.6%) were the most common complications experienced. Peritonitis as a complication was seen in 2(11.8%) subjects. 11 (64.7%) of the children were discharged from the hospital following resolution of AKI. 5(29%) of them died.

Conclusion: PD remains a good option in treatment of AKI requiring Renal replacement therapy with good outcome and few complications