Acute pediatric peritoneal dialysis: impact of an opt-out model and adaptable methods in a hospital in Nigeria
BACKGROUND Despite efforts to scale peritoneal dialysis (PD) uptake, access is still limited in Sub-Saharan Africa, including Nigeria. Thus, this study evaluated access to PD, cost-effectiveness, complications, and in-hospital mortality rate following the adoption of a local opt-out model approach for all children with acute kidney injury (AKI) that required PD.
METHODS This work was a retrospective review of 33 children with AKI that required dialysis between December 2014 and November 2016. PD was carried out using locally adaptable consumables in place of commercially produced consumables. All patients that required renal replacement therapy (RRT) were offered an option to opt-out irrespective of their financial status. Patients’ relevant data were retrieved from the case notes and analyzed.
RESULTS The median age was 7 years (range 3–12). 23 patients (70%) were males. Of the 33 patients that required RRT, 29 had PD. The children had an access rate of 88% (95% CI = 76.77–99.03). The access rate was not related to gender (p = 1.000), age group (p = 0.240), or socioeconomic status (p = 0.755). Complications were pericatheter leakage of fluid (n = 7, 24%), catheter malfunction (n = 5, 17%), abdominal wall edema (n = 3, 10%), scrotal edema (n = 2, 7%), and peritonitis (n = 1, 3%). In-hospital mortality was 3/29 (10%; 95% CI = 2.2–27.3). Cost analysis revealed that the cost of consumables was reduced by 88.5%.
CONCLUSIONS An opt-out model with the use of locally adaptable consumables improved PD access (88%) with a low in-hospital mortality rate.
Katibi OS, Adedoyin OT, Anoba S, Sowunmi FO, Olorunsola BO, Ibrahim OR, et al. Current trends in the management of acute kidney injury in children. Niger J Paed. 2013;40(3):314-20. https://doi.org/10.4314/njp.v40i4.9
Prendecki M, Blacker E, Sadeghi-Alavijeh O, Edwards R, Montgomery H, Gillis S, et al. Improving outcomes in patients with acute kidney injury: the impact of hospital based automated AKI alerts. Postgrad Med J. 2016;92(1083):9-13. https://doi.org/10.1136/postgradmedj-2015-133496
Kher V, Srisawat N, Noiri E, Benghanem Gharbi M, Shetty MS, Yang L, et al. Prevention and therapy of aute kidney injury in the developing world. Kidney Int Rep. 2017;2(4):544-58. https://doi.org/10.1016/j.ekir.2017.03.015
Chawla LS, Bellomo R, Bihorac A, Goldstein SL, Siew ED, Bagshaw SM, et al. Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup. Nat Rev Nephrol. 2017;13(4):241-57. https://doi.org/10.1038/nrneph.2017.2
Olowu WA, Niang A, Osafo C, Ashuntantang G, Arogundade FA, Porter J, et al. Outcomes of acute kidney injury in children and adults in sub-Saharan Africa: a systematic review. Lancet Glob Health. 2016;4(4):e242-50. https://doi.org/10.1016/S2214-109X(15)00322-8
Olowu WA. Renal failure in Nigerian children: factors limiting access to dialysis. Pediatr Nephrol. 2003;18(12):1249-54. https://doi.org/10.1007/s00467-003-1255-5
Lunyera J, Kilonzo K, Lewington A, Yeates K, Finkelstein FO. Acute kidney injury in low-resource settings: barriers to diagnosis, awareness, and treatment and strategies to overcome these barriers. Am J Kidney Dis. 2016;67(6):834-40. https://doi.org/10.1053/j.ajkd.2015.12.018
Esezobor CI, Ladapo TA, Lesi FE. Peritoneal dialysis for children with acute kidney injury in Lagos, Nigeria: experience with adaptations. Perit Dial Int. 2014;34(5):534-8. https://doi.org/10.3747/pdi.2013.00097
Ademola AD, Asinobi AO, Ogunkunle OO, Yusuf BN, Ojo OE. Peritoneal dialysis in childhood acute kidney injury: experience in southwest Nigeria. Perit Dial Int. 2012;32(3):267-72. https://doi.org/10.3747/pdi.2011.00275
Odetunde OI, Okafor HU, Uwaezuoke SN, Ezeonwu BU, Ukoha OM. Renal replacement therapy in children in the developing world: challenges and outcome in a tertiary hospital in southeast Nigeria. Sci World J. 2014;2014:903151. https://doi.org/10.1155/2014/903151
Adedoyin OT, Ibrahim OR, Abdurrahman LO, Nasir AA, Olorunshola BO, Abdulazeez TA, et al. Peritoneal dialysis in children with acute kidney injury: the Ilorin experience. Afr J Paed Nephrol. 2015;2(2):72-6.
World Health Organization and International Bank for Reconstruction and Development/The World Bank; 2017. Tracking universal health coverage: 2017 global monitoring report [Internet]. Geneva: World Health Organization; 2017. Available from: https://www.who.int/healthinfo/universal_health_coverage/report/2017/en/.
Mehta RL, Cerdá J, Burdmann EA, Tonelli M, García-García G, Jha V, et al. International Society of Nephrology's 0 by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385(9987):2616-43. https://doi.org/10.1016/S0140-6736(15)60126-X
Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138. https://doi.org/10.1038/kisup.2012.1
Oyedeji GA. Socioeconomic and cultural background of hospitalised children in Ilesha. Niger J Paed. 1985;12(4):111-7.
Vasudevan A, Phadke K, Yap HK. Peritoneal dialysis for the management of pediatric patients with acute kidney injury. Pediatr Nephrol. 2017;32(7):1145-56. https://doi.org/10.1007/s00467-016-3482-6
Anochie IC, Eke FU. Paediatric acute peritoneal dialysis in southern Nigeria. Postgrad Med J. 2006;82(965):228-30. https://doi.org/10.1136/pgmj.2005.039834
Naicker S, Ashuntantang G. End stage renal disease in Sub-Saharan Africa. Chronic Kidney Dis Disadvantaged Popul. 2017;125-37. https://doi.org/10.1016/B978-0-12-804311-0.00014-5
Barsoum RS, Khalil SS, Arogundade FA. Fifty years of dialysis in Africa: challenges and progress. Am J Kidney Dis. 2015;65(3):502-12. https://doi.org/10.1053/j.ajkd.2014.11.014
Abdelraheem M, Ali ET, Osman R, Ellidir R, Bushara A, Hussein R, et al. Outcome of acute kidney injury in Sudanese children-an experience from a sub-Saharan African unit. Perit Dial Int. 2014;34(5):526-33. https://doi.org/10.3747/pdi.2013.00082
Azat NFA. Indications and complications of peritoneal dialysis in children with acute renal failure, a single center experience. J Fac Med Baghdad. 2016;58(2):126-31.
Li PK, Burdmann EA, Mehta RL; World Kidney Day Steering Committee 2013. Acute kidney injury: global health alert. J Nephropathol. 2013;2(2):90-7. https://doi.org/10.5812/nephropathol.10449
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