FACULTY OF CLINICAL SCIENCES

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Author: search.filters.author.Ademola, A. D.Subject: search.filters.subject.Peritoneal dialysis

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    Paediatric dialysis at a tertiary hospital in South-West Nigeria: A 4-year report
    (Karger AG, Basel, 2022) Ademola, A. D.; Asinobi, A. O.; Alao, M. A.; Wade, A. W.
    Introduction: Dialysis is potentially lifesaving in children with acute kidney injury (AKI) or chronic kidney disease (CKD), but availability is limited in low-income countries and lower-middle-income countries (LMICs). Methods: In the present study, we perform a 4-year study of patients who received peritoneal dialysis (PD) or haemodialysis (HD) at the Paediatric Nephrology Unit of the University College Hospital Ibadan, Nigeria. Subgroup analysis was performed on patients with sepsis or malaria AKI who underwent HD or PD for predictors of in-hospital mortality. Results: A total of 167 children aged 7 days to 18 years, median 7 (interquartile range 3–12) years, (60.5% males) were studied. In total, 129 (77.2%) had AKI, while 38 had CKD. Regarding AKI, 83 children (64.3%) received HD only, 42 underwent PD only, while 4 underwent both HD and PD. Malaria AKI was treated with HD in 43 (51.8%) or PD in 8 (10.5%), while sepsis AKI was treated with HD in 20 (21.4%) or PD in 33 (78.6%). Mortality in AKI was 16.3% overall, 10.8% in children on HD only, and 26.2% in children on PD only. Patients with sepsis AKI had higher mortality compared to patients with malaria AKI (RR 7.96) [1.70–37.37]). Subgroup analysis showed that age, diagnosis, and dialysis modality were not independent risk factors for mortality. The aetiology of CKD was glomerulonephritis in 26 (68.4%): treatment was HD in 36 and PD in 2 with mortality being 26.3%. Conclusions: PD for AKI showed relatively good outcomes in a LMIC. However, funding and support for a formal dialysis program for the management of AKI and CKD are needed.
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    The use of an improvised Nasogastric Tube as a Peritoneal Dialysis Catheter and challenges of adaptation-A case report
    (African Paediatric Nephrology Association, 2019) Ademola, A. D.; Asinobi, A. O.; Akuse, R. M.
    Background: Paediatric dialysis for acute kidney injury (AKI) in developing countries may be a challenge because of limited access to standard gadgets. Adapted gadgets such as nasogastric tubes have been used to provide peritoneal dialysis (PD)in such settings. The nasogastric tube is usually inserted by the trocar or surgical technique which is cumbersome. We describe passage of the nasogastric tube for PD at the bedside by a technique that is considered easier than the trocar or surgical method. Case report and Treatment: A two- and-a-half-year-old girl presented with oliguric AKI secondary to malaria and intravascular haemolysis with suspected uraemic encephalopathy. Her serum creatinine on admission was 9.4mg/dl. A nasogastric tube was adapted as PD catheter, and was inserted by the modified Seldinger technique on post-admission day 1. Results: She received 39 cycles of PD over 5 days. Complications of PD included catheter outflow obstruction on post admission day 2 on account of which the catheter was replaced. She also developed Klebsiella pneumoniae peritonitis and on account of which the procedure was discontinued on post admission day 6. She regained normal urine output on post admission day 7. She was managed with iv meropenem based on the antibiotic sensitivity pattern with resolution of peritonitis. She showed significant improvement and her serum creatinine on post admission day 15 was 0.5 mg/dl.She was discharged home on post admission day 18. Conclusion: Nasogastric tube, adapted as PD catheter and inserted by modified Seldinger technique may be life-saving in patients with AKI in developing countries.
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    Paediatric peritoneal dialysis in a developing country: practice, challenges and opportunities
    (African Paediatric Nephrology Association, 2019) Asinobi, A. O.; Ademola, A. D.; Akuse, R. M.
    Background: The practice and challenges of peritoneal dialysis (PD) in a developing country may be uniquely different from what obtains in developed countries. Method: A review of the practice and challenges of PD in Nigeria as a case study and documentation of opportunities for improvement Review: There has been renewed interest in the provision of PD to children in acute kidney injury in Nigeria and this has led to adaptations such as use of nasogastric tubes as PD catheters and use of constituted PD fluid. The use of adaptations is lifesaving but complication rates may be higher than with the use of standard gadgets. Other challenges include limited availability and high cost of PD catheters and PD fluid. There are also challenges with the availability of expertise for the insertion of PD catheters and the PD procedure. Opportunities to advance paediatric PD include sustained efforts to provide PD with the use of adaptations, collection of data on outcomes of PD, advocacy for more support from government, non- governmental organisations and industry in the forms of insurance coverage, access to consumables and/or training in paediatric PD. Conclusion: Sustained provision of PD with adaptations, documentation of outcomes, and advocacy may lead to improvement in paediatric PD services.