article · Peritoneal Dialysis International
A retrospective study evaluated the first paediatric acute peritoneal dialysis programme established in the Democratic Republic of Congo at the University Hospital of Kinshasa. Between January 2018 and January 2019, forty-nine children aged four months to fifteen years were admitted with acute kidney injury, primarily caused by severe malaria and sepsis. Dialysis was indicated in thirty-five patients, with thirty-two receiving peritoneal dialysis administered by a healthcare team trained in bedside catheter insertion and local dialysis fluid preparation. Among the children treated with peritoneal dialysis, three-quarters achieved normal renal function three months after discharge. Peritonitis occurred in 6.2 percent of treated patients, while overall mortality reached 18.7 percent. The findings demonstrate that paediatric acute kidney injury can be managed successfully in low-resource settings using accessible techniques and locally prepared dialysis solutions.
Acute kidney injury is a major driver of paediatric mortality in low-resource regions where specialised renal care is scarce. Demonstrating that a small clinical team can safely deliver peritoneal dialysis using locally produced fluids offers a practical, low-cost framework to reduce child mortality from treatable conditions such as severe malaria and sepsis in resource-constrained hospitals.
This research represents an applied and tested clinical care model rather than a commercial product. The approach could inform hospital protocols and healthcare training initiatives seeking to establish low-cost peritoneal dialysis services in resource-limited settings, specifically through the local preparation of dialysis fluids and bedside catheter insertion techniques. Any operational rollout would primarily target public health systems, non-governmental organisations, and clinical training partnerships.
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In the Democratic Republic of Congo (DRC), acute kidney injury (AKI) contributes to the high rate of child mortality owing to the conjunction of poverty, deficiency of qualified health-care providers in pediatric nephrology, and the lack of pediatric dialysis programs. We aimed to describe the recent experience of the first pediatric acute peritoneal dialysis (PD) program in DRC. This is a retrospective cohort study on epidemiology, clinical features and outcomes of children admitted from January 2018 to January 2019 at the University Hospital of Kinshasa for AKI and treated with PD. This pediatric PD program started by a team of one physician and one nurse who were trained in the local production of PD fluids and bedside catheter insertion technique in Benin Republic. The training was jointly supported by the Flemish Inter-University Council (VLIR) TEAM project and Saving Young Lives (SYL) program of ISN, ISPD, EuroPD, and IPNA. From January 2018 to January 2019, 49 children (aged 4 months-15 years) were admitted for AKI mainly due to severe malaria and sepsis. Dialysis was indicated in 35 of 49 (71.4%), 32 of 35 (91.4%) were treated with PD, two with hemodialysis (HD) in adult ward and one died at admission. Data of the two patients transferred for HD were not available for follow-up. The main indications were uremia and prolonged anuria. Of 32 dialyzed patients, 24 (75%) recovered normal renal function 3 months after discharge. Peritonitis was observed in 2 of 32 (6.2%) patients and the mortality was 18.7%. This promising experience proves that with simple means including use of locally produced dialysis fluids and low peritonitis rates, we can effectively save lives of children suffering from AKI.
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DOI: 10.1177/0896860819887286
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