Bir Yaş Altındaki Hastalarda Periton Diyalizi Uygulamaları: Tek Merkez Deneyimi

Year 2018, , 13 - 18, 01.04.2018

Zeynep Yürük Yıldırım Cemile Pehlivanoğlu Alev Yllmaz Asuman Çoban Bağdagül Aksu Sevinç Emre Ilmay Bilge Zeynep İnce Ümmiye Kavas Gülay Erden Aydan Şirin

https://doi.org/10.5222/j.child.2018.92485

Abstract

Amaç: Periton diyalizi PD , yenidoğan ve sütçocuğu dönemlerinde akut ve kronik böbrek yetersizliğinde en sık uygulanan renal replasman tedavisi olmakla birlikte, uygulamada birçok sorunla karşılaşılmaktadır. Çalışmanın amacı, bu hasta grubunda PD uygulamalarında görülen sorunları belirlemektir.Gereç ve Yöntem: 2002-2013 yılları arasında bilim dalımızda 1 yaş altındayken akut veya kronik PD uygulanan 39 hastanın dosyaları retrospektif olarak incelendi. Yenidoğan ve sütçocuğu grubundaki hastalar PD uygulaması ve komplikasyonları açısından karşılaştırıldı. Bulgular: Akut PD 27 15 yenidoğan, 12 sütçocuğu hastaya uygulandı. Ortalama akut PD süresi açısından yenidoğan ve sütçocukları arasında fark yoktu 9.2±10,5 ve 11.6±13.7 gün . Komplikasyon oranları açısından yenidoğan %173.3 ve sütçocukları arasında %91.6 fark yoktu p=0.183 . Nonenfeksiyöz komplikasyonlar yenidoğanlarda daha sıktı ve en sık görülen komplikasyon kateter sızıntısıydı. Nonenfeksiyöz kompliksyonlar nedeni ile yenidoğanların %46.6’sında ve sütçocuklarının %8.3’ünde kateter yenilendi. Mortalite oranları yenidoğanlarda %66.78 n=10 , sütçocuklarında %58.3 olarak n=7 bulundu p=0.706 . Kronik PD 12 hastaya 8 yenidoğan, 4 sütçocuğu uygulandı. Kronik PD altında ortalama izlem süresi yenidoğanlarda 30.6±25.3 ay ve sütçocuklarında 23,5±23.2 aydı. Genel komplikasyonların oranı açısından iki grup arasında fark olmamakla birlikte, kateter sızıntısı, kateter obstrüksiyonu gibi nonenfeksiyöz komplikasyonlar yenidoğanlarda daha sıktı %212,5 vs %175 p=0.035 . Enfeksiyöz komplikasyonlar sütçocuklarında daha sık olmasına rağmen iki grup arasındaki fark istatistiksel olarak anlamlı bulunmadı %150 vs %112,5 p=0.646 . Mortalite oranları yenidoğanlarda %50 n=4 , sütçocuklarında %50 olarak n=2 bulundu.Sonuç: Yenidoğanlarda akut ve kronik PD’nin en sık komplikasyonu kateter sızıntısı ve obstrüksiyonu olarak saptanırken, sütçocuğunda kronik PD’de en sık komplikasyonunun peritonit olduğu saptandı

Keywords

Periton diyalizi, yenidoğan, bebek, komplikasyon

Peritoneal Dialysis In Infants: Single Center Experience

Abstract

Objective: Peritoneal dialysis PD is the most commonly used renal replacement therapy in acute and chronic renal insufficiency during neonatal and infantile periods, but many problems are encountered in practice. The aim of the study is to identify the problems seen in PD applications in this group of patients.Material and Methods: Between 2002 and 2013, files of 39 patients under 1 year of age who underwent acute or chronic PD in our department were retrospectively reviewed. Patients in the neonatal and infantile group were compared in terms of PD applications and their complications.Results: Acute PD was performed in a total of 27 patients 15 newborns, 12 infants . Mean duration of acute PD was not different in newborns and infants 9.2±10.5 vs 11.6±13.7 days . Complication rate was not different in newborns 173.3 % and in infants 91.6% p=0.183 . Non-infectious complications were more frequent in newborns and the most common complication was pericatheter leakage. The catheter was replaced in 46.6% of the newborns and in 8.3% of the infants due to non-infectious complications. Mortality rates were 66.7% n=10 in newborns and 58.3% n=7 in infants p=0.706 . Chronic PD was performed in a total 12 patients 8 newborns, 4 infants . Mean followup duration of chronic PD was 30.6±25.3 months in newborns, and 23.5±23.2 months in infants. Although overall complication rate was not different between two groups, non-infectious complications such as pericatheter leakage, and catheter obstruction were more frequent in newborns 212.5% vs 175% p=0.035 . Although infectious complications were more common in infants 150% vs 112.5% , there was no statistical significant difference between both groups p=0.646 . Mortality rates were found to be 50% n=4 in newborns and 50% n=2 in infants.Conclusion: The most important complications of acute and chronic PD in the newborns were pericatheter leakage and catheter obstruction while peritonitis was the most common problem in chronic infantile PD

Keywords

Peritoneal dialysis, newborn, infant, complication

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