“Something has changed”: Peritoneal dialysis in children, today

Abstract

In the last decade a change in the cultural and socio-economic attitude of the caregivers of children in dialysis has been observed. This includes an increase in the number of mono-parental or split families, an increase in the number of immigrant families, as well as an increase of poverty conditions and need for working for both parents. A higher number of patients with severe comorbidities, related to extreme prematurity or genetic syndromes, are now considered for dialysis treatment, while this was not the case in the past. Encapsulating peritoneal sclerosis with a high fatality rate, only partially related to a high incidence of peritonitis or long duration of peritoneal dialysis, has become a clear, though rare, risk for those who start peritoneal dialysis. Finally, a substantial improvement in dialysis technology has been observed, particularly in the field of extracorporeal dialysis. On the basis of all the above mentioned factors, the equation “children on dialysis = children on peritoneal dialysis” does not seem so completely valid today. The choice of the best dialysis treatment for the child with ESRD and his family depends on the evaluation of a multidisciplinary team, which considers not only the clinical aspects of the child but also the psycho-social and economic factors related to the treatment and the family. This way, the frequent dropouts of some categories of pediatric peritoneal dialysis patients can be prevented. As a consequence of the previous considerations, especially from the epidemiological point of view, in our center we observed a decrease in the number of children treated with peritoneal dialysis and an increase of those on hemodialysis over the last 10 years.