Pediatric peritoneal dialysis in Korea: practical solutions to the problems of peritoneal dialysis for children.

PURPOSE: To find and solve the common problems of peritoneal dialysis (PD) by analyzing the clinical data of pediatric PD performed in Korea.

METHODS: We looked at 264 cases of continuous ambulatory peritoneal dialysis (CAPD) and acute PD that were performed in 18 institutions of pediatric nephrology in Korea from November 1987 to October 1997.

RESULTS: CAPD was performed in 114 cases. The mean age of the patients was 10.5+/-6.6 years, and the male-to-female ratio was 1.4:1. The original causes of end-stage renal disease (ESRD) were proven in 92 cases (81%). The most common renal diseases were focal segmental glomerulosclerosis (17%), reflux nephropathy (11%), and chronic glomerulonephritis (11%). Mean duration of CAPD was 20 months+/-16.9 months. Peritonitis was the most common complication, and the peritonitis incidence was 0.96 episode per patient-year. Other complications were exit-site infection in 10 cases, obstruction in 7 cases, and leakage of dialysate in 6 cases. The most common etiologic organism of peritonitis was Staphylococcus aureus and the next most common was coagulase-negative staphylococcus. Acute PD was performed in 150 cases. The most common underlying causes were congenital heart disease, hemolytic uremic syndrome, sepsis, and dehydration. The mean duration was 10.3+/-11.3 days. The most common complication was peritonitis (78.3%). The most common etiologic organisms of peritonitis were Staphylococcus aureus, coag-neg staphylococcus, Acinetobacter, and Pseudomonas.

CONCLUSION: Reflux nephropathy should be emphasized in early diagnosis and treatment to prevent ESRD. Incidence of congenital anomaly (7%) as a original cause of ESRD was relatively low in Korea. Growth status was not significantly improved after CAPD. In acute PD, the incidence of peritonitis rapidly increased at 2 weeks after the start of dialysis.