CLINICAL PROFILE AND OUTCOME OF PEDIATRIC MAINTENANCE HEMODIALYSIS A PROSPECTIVE, OBSERVATIONAL, HOSPITAL BASED STUDY.

Abstract

Introduction Dialysis forms the cornerstone of therapy for most patients with chronic kidney diseases stage V, End Stage Renal Disease (ESRD) and many patients with Acute Kidney Injury (AKI). Congenital disorders, including congenital anomalies of the kidney and urinary tract (CAKUT) and hereditary nephropathies, are responsible for about two thirds of all cases of CKD in developed countries, while glomerulonephritis in developing countries predominates as cause for CKD. Most paediatric patients continue to have haemodialysis till a source becomes available for renal transplant, some may die waiting kidney transplant due to complications and some might change dialysis centre at parents wish. Aims To identify the causes of Chronic Kidney Disease in children and to assess the outcome and impact of paediatric haemodialysis on Growth parameters and on laboratory parameters. Materials And Methods this study is Prospective observational hospital based study done at Pediatric hemodialysis centre at Department of Pediatrics and Neonatology, Batra Hospital and Medical Research Centre, New Delhi. Patients coming to Batra hospital for pediatric maintenance hemodialysis were study subjects. A total of 50 patients were taken up for study. Detailed history taking, clinical examination and relevant investigations of subjects were done. Dialysis had been performed with Fresenius 2008K machines and hollow fiberpolysulfone dialysis filters (Fresenius, Bad Homburg, Germany), using standard bicarbonate dialysis solution. Following hemodialysis procedure the child was followed till the end point. Results . Our study showed prevalence of CKD more in males. In our study out of 50 cases 27(54%) cases wer found to be having glomeruolnephritis as a cause of CKD. In our study out of 50 cases :30 (60%)cases were followed till the end of study 9 (18%)cases terminated dialysis on parent’s wish and dialysis may be continued at another centre.6 (12%)cases died during the study period And 5 (10%)cases underwent renal transplantation. Height improved on follow up and lab. Parameters like Hb,phosphate,crea also improved. Conclusion This study showed that in developing countries set up most common cause of CKD in paediatric age group is Glomerulonephritis followed by CAKUT and other congenital anomalies of urinary tract. Haemodialysis in children improves height, anemia, and other lab. Parameters like phosphate, creatinine and others. Most paediatric patients followed maintenance haemodialysis till end of study, some died, and some shifted to other haemodialysis centre while about 10% cases underwent kidney transplantation. There is a greater need for establishing multiple pediatric haemodialysis centres all over India, including rural set up for increasing the long term survival in pediatric patients with CKD ,ESRD and improving their quality of life.