Childhood Kidney Diseases

Korean Society of Pediatric Nephrology (대한소아신장학회)
권호 표지
DOI QR코드

DOI QR Code

Current Status of Children on Peritoneal Dialysis in Korea : A Cross-Sectional Multicenter Study

소아복막투석의 현황: 다기관 공동연구 결과보고

  • Youn, Ji-Seok (Department of Pediatrics, University of Ulsan, College of Medicine Asan Medical Center) ;
  • Lee, Joo-Hoon (Department of Pediatrics, University of Ulsan, College of Medicine Asan Medical Center) ;
  • Park, Young-Seo (Department of Pediatrics, University of Ulsan, College of Medicine Asan Medical Center) ;
  • Yim, Hyung-Eun (Department of Pediatrics, College of Medicine, Korea University) ;
  • Paik, Kyung-Hoon (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Kee-Hwan (Department of Pediatrics, College of Medicine, Korea University) ;
  • Ha, Il-Soo (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Cheong, Hae-Il (Department of Pediatrics, Seoul National University Children's Hospital) ;
  • Choi, Yong (Department of Pediatrics, Seoul National University Children's Hospital)
  • 윤지석 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 이주훈 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박영서 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 임형은 (고려대학교 의과대학 소아과학교실) ;
  • 백경훈 (성균관대학교 의과대학 소아과학교실) ;
  • 유기환 (고려대학교 의과대학 소아과학교실) ;
  • 하일수 (서울대학교 의과대학 소아과학교실) ;
  • 정해일 (서울대학교 의과대학 소아과학교실) ;
  • 최용 (서울대학교 의과대학 소아과학교실)
  • Published : 2009.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Peritoneal dialysis (PD) is the major form of dialysis in use for infants and children with end-stage renal disease (ESRD). The aim of this study was to gain insight into the current status of children on PD in Korea. Methods : In May 2008, questionnaires were sent to the pediatric nephrologists via e-mail. Four centers replied and those data were reviewed. Results : A total of 103 patients were included in this study. Male to female ratio was 1.6:1. Mean age was $11.5{\pm}4.9$ years (0-19 years). Primary renal diseases diagnosed were as follows: primary glomerular disease (34%), chronic pyelonephritis-reflux nephropathy (14.6%), systemic disease (9.7%), renal hypoplasia/dysplasia (8.7%), heredofamilial disease (6.8%), vascular disease (3.9%), drug-induced nephropathy (1.0%), and unknown (12.6%). PD modalities were as follows: CAPD (42.7%), CCPD (27.2%), NIPD (11.7%), and Hybrid (18.4%). Weekly total Kt/V was $2.1{\pm}0.7$ (0.3-4.1). Results of peritoneal equilibrium test were as follows: low 36.8%, low average 31.6%, high average 19.7%, and high 11.8%. Z-score for weight was $-1.00{\pm}1.20$ (-4.54~+2.50). Z-score for height was $-1.55{\pm}1.65$ (-9.42~+1.87). Growth hormone was administered in 24.3% of patients. Anti-hypertensive drugs were administered in 64.0% of patients. Laboratory findings were as follows: hemoglobin $10.5{\pm}1.4$ g/dL, calcium $9.7{\pm}0.7$ mg/dL, phosphorus $5.4{\pm}1.4$ mg/dL, and parathyroid hormone $324.2{\pm}342.8$ pg/mL. Conclusion : Primary glomerular disease was the most common cause of ESRD. CAPD was the most prevalent PD modality. Low and low average peritoneal transport type were common. Growth disturbance were noted in many patients. Some patients had hypertension even with anti- hypertensive drugs. Calcium-phosphorus levels were maintained adequately, but many patients had secondary hyperparathyroidism.

목적 : 복막투석요법은 말기 신부전 환아에서 신이식 다음으로 추천되는 신대체 요법으로 현재 말기 신부전 환아들의 장기 생존율 향상으로 복막투석요법 환아 수가 점차 증가하고 있다. 현재 한국 내 복막투석요법 소아에 대한 현황을 파악하고자 이번 연구를 시행하였다. 방법 : 2008년 5월 국내 4개 대학병원을 대상으로 전자우편 설문조사를 시행하였고 현재 3개월 이상 복막투석 중인 103명의 소아를 대상으로 자료를 분석하였다. 결과 : 대상 환아 103명의 남녀비는 1.6:1로 남아가 많았고, 평균 연령은 $11.5{\pm}4.9$세(0-19세), 투석시작 전 말기 신부전의 원인 중 원발성 사구체 질환이 34%로 가장 많았다. 복막투석의 형태는 지속적 외래 복막투석법이 42.7%로 가장 많았고, 주간 전체 Kt/V는 $2.1{\pm}0.7$ (0.3-4.1), 복막평형검사상 저 투과성이 36.8%, 저평균 투과성이 31.6%으로 가장 많은 비율을 차지했다. 체중 표준편차점수(Z-score)는 $-1.00{\pm}1.20$(-4.54-+2.50), 신장 표준편차점수(Z-score)는 $-1.55{\pm}1.65$(-9.42-+1.87)였고, 성장호르몬은 24.3%에서 투여 중이었다. 38.8%의 환아에서 이완기 혹은 수축기 혈압 95 백분위수 이상의 고혈압을 보였고, 64.0%의 환아가 항고혈압제 투여 중이었다. 평균 혈청 혈색소는 $10.5{\pm}1.4$ g/dL, 평균 혈청 칼슘은 $9.7{\pm}0.7$ mg/dL, 평균 혈청 인은 $5.4{\pm}1.4$ mg/dL, 평균 부갑상선 호르몬은 $324.2{\pm}342.8$ pg/mL였다. 결론 : 국내 복막투석요법 소아에서 원발성 사구체 질환이 소아 말기 신부전의 가장 흔한 원인이고, 지속적 외래 복막투석법이 가장 흔히 사용되는 복막투석 형태이며, 복막평형검사상 저 투과성과 저평균 투과성이 가장 많았다. 대부분의 환아가 적절한 신장과 체중을 유지하고 있었으나 저신장 환아의 경우 성장 호르몬 치료가 제대로 이루어지지 않고 있었고 여전히 많은 환아에서 빈혈과 고혈압이 관찰되었다. 혈청 칼슘과 인은 비교적 정상범위를 유지하고 있으나 많은 환아가 이차성 부갑상선 기능 항진증을 보였다.

Keywords

References

  1. Gokal R, Mallick NP. Peritoneal dialysis. Lancet 1999;353:823-8. https://doi.org/10.1016/S0140-6736(98)09410-0
  2. van der Heijden BJ, van Dijk PC, Verrier-Jones K, Jager KJ, Briggs JD. Renal replacement therapy in children: data from 12 registries in Europe. Pediatr Nephrol 2004;19:213-21. https://doi.org/10.1007/s00467-003-1376-x
  3. Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol 2007;22:1999-2009. https://doi.org/10.1007/s00467-006-0410-1
  4. Moon JS, Lee SY, Nam CM, Choi JM, Choe BK, Seo JW, et al. 2007 Korean national growth charts: review of developmental process and an outlook. Korean J Pediatr 2008;51:1-25. https://doi.org/10.3345/kjp.2008.51.1.1
  5. Hong CY, et al. Textbook of pediatrics. 9th ed. Seoul: Daehan Printing & Publishing Co. 2007:1241-3.
  6. Lee JK. Standard blood pressure of child and adolescent in 2005. Program and Abstract, 56th Annual Spring Meeting of The Korean Pediatric Society; 2006 Apr 28-29; Yong-Pyung, Seoul: The Korean Pediatric Society 2006:63-90.
  7. Kim PK, Kim JH. Pediatric peritoneal dialysis in Korea: practical solutions to the problems of peritoneal dialysis for children. Perit Dial Int 1999;19 Suppl 2:S489-92.
  8. Hattori S, Yosioka K, Honda M, Ito H. The 1998 report of the Japanese National Registry data on pediatric end-stage renal disease patients. Pediatr Nephrol 2002;17:456-61. https://doi.org/10.1007/s00467-002-0848-8
  9. Fine RN, Ho M. The role of APD in the management of pediatric patients: a report of the North American Pediatric Renal Transplant Cooperative Study. Semin Dial 2002;15:427-9. https://doi.org/10.1046/j.1525-139X.2002.00105.x
  10. Verrina E, Edefonti A, Gianoglio B, Rinaldi S, Sorino P, Zacchello G, et al. A multicenter experience on patient and technique survival in children on chronic dialysis. Pediatr Nephrol 2004;19:82-90. https://doi.org/10.1007/s00467-003-1270-6
  11. Fabian Velasco R, Lagunas Munoz J, Sanchez Saavedra V, Mena Brito Trejo JE, Qureshi AR, Garcia-Lopez E, et al. Automated peritoneal dialysis as the modality of choice: a single-center, 3-year experience with 458 children in Mexico. Pediatr Nephrol 2008;23:465-71. https://doi.org/10.1007/s00467-007-0638-4
  12. National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for 2006 updates : hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. Am J Kidney Dis 2006;48:S1-322. https://doi.org/10.1053/j.ajkd.2006.07.015
  13. Canada-USA (CANUSA) multicentre study of peritoneal dialysis adequacy: description of the study population and preliminary results. CANUSA Peritoneal Dialysis Study Group. Adv Perit Dial 1992;8:88-92.
  14. Warady BA. Should the DOQI adequacy guidelines be used to standardize peritoneal dialysis in children? Perit Dial Int 2002;21 Suppl 3:S174-8.
  15. Twardowski ZJ. Clinical value of standardized equilibration tests in CAPD patients. Blood Purif 1989;7:95-108. https://doi.org/10.1159/000169582
  16. Warady BA, Alexander SR, Hossli S, Vonesh E, Geary D, Watkins S, et al. Peritoneal membrane transport function in children receiving long-term dialysis. J Am Soc Nephrol 1996;7:2385-91.
  17. Chung SH, Chu WS, Lee HA, Kim YH, Lee IS, Lindholm B, et al. Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients. Perit Dial Int 2000;20:541-7.
  18. Churchill DN, Thorpe KE, Nolph KD, Keshaviah PR, Oreopoulos DG, Page D. Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1998;9:1285-92.
  19. Schaefer F, Klaus G, Mehls O. Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group. J Am Soc Nephrol 1999;10:1786-92.
  20. Edefonti A, Mastrangelo A, Paglialonga F. Assessment and monitoring of nutrition status in pediatric peritoneal dialysis patients. Perit Dial Int 2009;29 Suppl 2:S176-9.
  21. Blumenkrantz MJ, Gahl GM, Kopple JD, Kamdar AV, Jones MR, Kessel M, et al. Protein losses during peritoneal dialysis. Kidney Int 1981;19:593-602. https://doi.org/10.1038/ki.1981.57
  22. Seikaly MG, Salhab N, Warady BA, Stablein D. Use of rhGH in children with chronic kidney disease: lessons from NAPRTCS. Pediatr Nephrol 2007;22:1195-204. https://doi.org/10.1007/s00467-007-0497-z
  23. Wong CS, Gipson DS, Gillen DL, Emerson S, Koepsell T, Sherrard DJ, et al. Anthropometric measures and risk of death in children with end-stage renal disease. Am J Kidney Dis 2000;36:811-9. https://doi.org/10.1053/ajkd.2000.17674
  24. Hadtstein C, Schaefer F. Hypertension in children with chronic kidney disease: pathophysiology and management. Pediatr Nephrol 2008;23:363-71. https://doi.org/10.1007/s00467-007-0643-7
  25. KDOQI. K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43:S1-290.
  26. Mitsnefes M, Stablein D. Hypertension in pediatric patients on long-term dialysis: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS). Am J Kidney Dis 2005;45:309-15. https://doi.org/10.1053/j.ajkd.2004.11.006
  27. Seeman T, Gilik J, Vondrak K, Simkova E, Flogelova H, Hladikova M, et al. Regression of left-ventricular hypertrophy in children and adolescents with hypertension during ramipril monotherapy. Am J Hypertens 2007;20:990-6. https://doi.org/10.1016/j.amjhyper.2007.03.009
  28. Ozcakar ZB, Yalcinkaya F, Tutar E, Cakar N, Ucar T, Elhan A, et al. Hypertension and left ventricular hypertrophy in pediatric peritoneal dialysis patients: ambulatory blood pressure monitoring and echocardiographic evaluation. Nephron Clin Pract 2006;104:c101-6. https://doi.org/10.1159/000093997
  29. Lilien MR, Groothoff JW. Cardiovascular disease in children with CKD or ESRD. Nat Rev Nephrol 2009;5:229-35. https://doi.org/10.1038/nrneph.2009.10
  30. Koshy SM, Geary DF. Anemia in children with chronic kidney disease. Pediatr Nephrol 2008;23:209-19. https://doi.org/10.1007/s00467-006-0381-2
  31. Keithi-Reddy SR, Singh AK. Hemoglobin target in chronic kidney disease: a pediatric perspective. Pediatr Nephrol 2009;24:431-4. https://doi.org/10.1007/s00467-008-0902-2
  32. KDOQI. KDOQI clinical practice guideline and clinical practice recommendations for anemia in chronic kidney disease: 2007 update of hemoglobin target. Am J Kidney Dis 2007;50:471-530. https://doi.org/10.1053/j.ajkd.2007.06.008
  33. Amaral S, Hwang W, Fivush B, Neu A, Frankenfield D, Furth S. Association of mortality and hospitalization with achievement of adult hemoglobin targets in adolescents maintained on hemodialysis. J Am Soc Nephrol 2006;17:2878-85. https://doi.org/10.1681/ASN.2005111215
  34. Wesseling K, Bakkaloglu S, Salusky I. Chronic kidney disease mineral and bone disorder in children. Pediatr Nephrol 2008;23:195-207. https://doi.org/10.1007/s00467-007-0671-3

Cited by

  1. Experience with Pediatric Kidney Transplantation, 1985-2016: A Single Regional Center Study vol.21, pp.2, 2017, https://doi.org/10.3339/jkspn.2017.21.2.69