Paediatric Renal Dialysis at the End of the 20th Century in Ibadan Nigeria

Aim: To document the conditions requiring dialysis in children at the University College Hospital, Ibadan Nigeria, at the end of the 20th century, as well as the available dialytic modalities and short-term outcomes of dialysis for future comparisons.

Patients and Methods: The data of all children aged 15 years and below who underwent peritoneal dialysis or haemodialysis in the Dialysis Unit between January 1990 and December 1999 were reviewed. A descriptive analysis of patients’ demography, aetiology of kidney failure, dialytic modalities and short-term outcome in these patients was performed. The primary outcome measure was mortality.

Results: Sixty-six children comprising 14 (21%) boys and 52 (79%) girls underwent dialysis. The mean age was 11.9 (SD 3.9) years. Fifty-eight (88%) underwent peritoneal dialysis and 8 (12%) haemodialysis. A definitive diagnosis of Stage 5 chronic kidney Disease was made in 25 (38%), acute kidney injury in 23(35%) and acute kidney injury-on-chronic kidney disease in 6 (8%).The major underlying conditions were the nephrotic syndrome, acute glomerulonephritis and chronic glomerulonephritis. Others were diethylene glycol poisoning, malignancies and sepsis. Only acute dialysis was offered because of limited resources.

Overall 25 died, giving a mortality rate of 37.9% with 12 (48%) and 22 (88%) patients dying within 3 days and 2 weeks of presentation respectively. Thirteen of the 25 (52%) patients in Stage 5 CKD, and 9 (39.1%) of the 23 with AKI, died and the mortalities were related more to the aetiologies.

Conclusion: Acute glomerulonephritis and Nephrotic syndrome were the major causes of AKI while chronic glomerulonephritis was the major identified cause of Stage 5 CKD. The available dialytic modalities were peritoneal dialysis and the then newly introduced haemodialysis. Patients had no insurance cover and paid out of pocket for treatment thereby limiting the duration of dialysis. The short-term outcome compared favourably with outcomes in centres with similar predicaments.