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2017 ; 12
(5
): e0178233
Nephropedia Template TP
gab.com Text
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English Wikipedia
Treatment of AKI in developing and developed countries: An international survey
of pediatric dialysis modalities
#MMPMID28557999
Raina R
; Chauvin AM
; Bunchman T
; Askenazi D
; Deep A
; Ensley MJ
; Krishnappa V
; Sethi SK
PLoS One
2017[]; 12
(5
): e0178233
PMID28557999
show ga
HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and
mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%.
Treatment of pediatric AKI is a source of debate in varying geographical regions.
Currently CRRT is the treatment for pediatric AKI, but limitations due to cost
and accessibility force use of adult equipment and other therapeutic options such
as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more
cost-effective measures would likely be used in developing countries due to
lesser resource availability. METHODS: A 26-question internet-based survey was
distributed to 650 pediatric Nephrologists. There was a response rate of 34.3%
(223 responses). The survey was distributed via pedneph and pcrrt email servers,
inquiring about demographics, technology, resources, pediatric-specific supplies,
and preference in renal replacement therapy (RRT) in pediatric AKI. The main
method of analysis was to compare responses about treatments between
nephrologists in developed countries and nephrologists in developing countries
using difference-of-proportions tests. RESULTS: PD was available in all centers
surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was
available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p
= 0.45) centers of developed and developing world respectively. In developing
countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies,
while in developed countries it was found that physicians favored HD (72%, p =
0.00) or CRRT (24%, p = 0.041) in infants. CONCLUSIONS: Lack of availability of
resources, trained physicians and funds often preclude standards of care in
developing countries, and there is much development needed in terms of meeting
higher global standards for treating pediatric AKI patients. PD remains the main
modality of choice for treatment of AKI in infants in developing world.
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