Challenges in Peritoneal Dialysis: Case Study Experience from a Low Resource Setting

Introduction: Acute kidney injury (AKI) is a common complication, affecting almost one-third of critically sick children and also noncritically ill children admitted to wards. It is common in pediatric intensive care units (ICUs) and has an incidence of 10% to 35%. AKI is also common in wards, especially in children receiving aminoglycosides and multiple nephrotoxins during their hospital stay. In the developing world, especially in rural regions, the etiological factors remain as dehydration, sepsis, and hemolytic uremic syndrome. Peritoneal dialysis (PD) is a method to treat acute kidney injury (AKI) and is a commonly accepted method. There are different types of catheters and various insertion methods although the results in their outcomes do not differ a lot. We share our first experience of peritoneal dialysis using Foley catheter in a low resource setting. Case Presentation: 2years old boy who was admitted with complain of fever, cough. This is a known patient with global developmental delay. The patient was started on IV Ampicillin and Metronidazole as aspiration Pneumonia was suspected. On day 2 of admission, mother reported the child had not passed urine for 3days and clinically the patient was found to be in Septic Shock. The patient was given a bolus of IV Ringers Lactate and later was given packed red blood cells. Urine catheter after 24hours had 5mls of urine despite maintenance fluid, blood and bolus IV fluids. The patient was started on IV Meropenem (adjusted to GFR) and Metronidazole was continued. Day 5 after admission, patient still had no change in urine ouput. Peritoneal Dialysis was initiated and patient was transferred to ICU. Whilst in ICU, patient received several cycles of Peritoneal Dialysis (2.5% PD at 290mls 2hrly) and was improving clinically from Glasgow Coma Score (from 3 to 9), urea decreased, creatinine decreased and urine output increased to 104mls per 24hours.The patient had hyperkalemia and suffered cardiac arrest but was resuscitated and recovered. On day 10, the patient sustained respiratory failure and was desaturating to 64%. He was put on Ventilator but 9hours later succumbed due to cardiac arrest.