Acute peritoneal dialysis adequacy among children at a national referral hospital in Kenya: a cross-sectional study in a resource-limited setting

Abstract

Abstract Background: Acute peritoneal dialysis (PD) is an important renal replacement therapy for children with acute kidney injury (AKI), particularly in resource-limited settings. Inadequate PD may result in persistent uremia, prolonged hospitalization, increased mortality, and transition to hemodialysis. Dialysis adequacy is commonly assessed using urea and creatinine clearance, which are influenced by prescription parameters such as fill volume, dwell time, and dialysate dextrose concentration. However, there is limited data on target clearance values for children undergoing acute PD. This study aimed to assess PD adequacy and describe urea and creatinine clearance among children receiving acute PD at a national referral hospital in Kenya. Methods: A cross-sectional study was conducted at Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya. We enrolled children who were starting peritoneal dialysis over a period of 5 months in the paediatric renal unit. Records of total drain volumes and serum and effluent concentrations of electrolytes, urea, and creatinine before and after 24 hours of dialysis were obtained via questionnaires. Daily urea and creatinine clearance were calculated for each child. A paired t-test was used to compare mean serum urea and creatinine concentrations before and after the first 24 hours of dialysis because measurements were obtained from the same participants and the data was approximately normally distributed. Descriptive analysis was used to compare solute clearance between groups of dialysate dextrose concentrations. Results: 64children were enrolled at a median age of 18days, and 43% were female. The median daily creatinine clearance was 5.13 L/day/1.73m 2 , and the median daily urea clearance was 1.03. There was a statistically significant reduction in mean serum urea and creatinine after the first day of dialysis. Sick neonates were at a higher risk of developing AKI than infants and older children. Conclusion: Peritoneal dialysis achieved measurable clearance of urea and creatinine among patients admitted to the paediatric renal unit at Kenyatta National Hospital.