WM Lai, MC Chiu, KC Tse, SC Lau, PC Tong

Abstract

We report the 6 ½ years experience of automated peritoneal dialysis (APD) in 32 Chinese children who were put on the APD programme in the Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital since November 1996. There were 15 boys and 17 girls and the mean age of start of APD was 11.2±5.8 years (range 0.1-21.5 years). The mean duration of APD was 27.7±22.3 months (range 3-79 months). The primary diagnosis were glomerulonephropathies (40.6%), hypoplastic/dysplastic kidneys (31.3%), pyelonephritis (9.4%), and other renal diseases (18.8%). Peritoneal equilibration test showed that 14 patients (48.3%) were high transporter, 10 patients (34.5%) were high average transporter and 4 patients (13.8%) were low average transporter. Seven patients (21.8%) were on nightly intermittent peritoneal dialysis. Seventeen patients (53.1%) on continuous cyclic peritoneal dialysis (CCPD), 4 patients (12.5%) on high dose CCPD, and 3 patients (9%) on tidal peritoneal dialysis. The incidence of peritonitis rate was low with 1 infection every 80.5 patient months or annualised peritonitis rate 0.149. Causative organisms included gram positive organisms (45.5%), gram negative organisms (27.2%), atypical mycobacterium (9%), and culture negative (18.2%). The incidence of exit site infection was 1 episode per 23.5 patient months. The mean weekly Kt/V urea was 2.46±0.58 and mean combined weekly creatinine clearance was 59.3±19.5 litre/1.73 m². Eighteen patients (56.2%) remained on APD. Ten patients (31.3%) were successfully transplanted with functioning graft. One patient (3.1%) was on chronic HD and there were 3 deaths. We concluded that APD is a good dialysis modality for paediatric end stage renal failure patients and there was a low incidence of peritonitis while achieving adequate dialysis in the majority of patients.

我們報告一項長達 6 年半，自 1996 年 11 月起在瑪嘉烈醫院，兒童及青少年科進行的研究─全自動腹膜透析( APD)計劃，敍述 32 名使用 APD 的華人兒童的臨床經驗。15 男，17 女，開始 APD 計劃的平均年齡為 17.2±5.8 歲(範圍：0.1-21.5 歲)，參與 APD 計劃的平均時間為 27.7±22.3 月(範圍 3-79 個月)。其診斷分別為：腎小球腎病(40.6%)，腎發育不全或不良( 31.3%)，腎盂腎炎(9.4%)和其他腎病(18.8%)。腹膜平衡測試顯示：高轉運者病人 14 名(48.3%)，高平均值轉運者病人 10 名(34.5%)和低平均值轉運者病人4 名(13.8%)。7 名病人(21.8%)是夜間間歇使用腹膜透析，17 名病人(53.1%)是使用連續性週期腹膜透析(CCPD)，4 名病人(12.5%)使用高劑量 CCPD，和 3 名病人(9%)使用潮式腹膜透析。其腹膜炎發生率甚低，為 80.5 患病月中出現一次或全年的腹膜炎發生率為 0.149。致病菌包括革蘭氏陽性細菌(45.5%)，革蘭氏陰性細菌( 27.7%)，非典型粘膜菌(9%)和陰性培養(18.2%)。發生率每 23.5 患病月中有一次感染出現。每週 Kt/V 尿素平均值為 2.46±0.58 和每週肌酐清除率為 59.3±19.5 升/1.73 平方米。18 名病人(56.2%)仍使用 APD。10 名病人(31.3%)已成功作腎移植。1 名病人(31%)需慢性血液透析(HD)和 3 名病人死亡。結論是對於末期兒科腎衰竭患者，APD 是一項較佳的透析方法。而且腹膜炎的發生率在大部份接受足夠透析的患者中亦較低。