The Challenges of Treating Children with Renal Failure in a Developing Country

apid advances in the field of pediatric nephrol- ogy—particularly over the last four decades in the areas of dialysis and transplantation—have revo- lutionized the care of children with renal failure. Chil- dren with renal failure in the developed world have a good chance for survival and a reasonably good qual- ity of life. Unfortunately, the benefits of technological progress have yet to reach the developing world. The present paper narrates the experience of deal- ing with children with renal failure at the Children's Kidney Care Center, St. John's Medical College Hos- pital, Bangalore, India. Strategies to possibly improve the outcomes of children with renal failure in devel- oping countries are discussed. PATIENTS We reviewed and analyzed the case records of chil- dren requiring dialysis therapy over the past 20 months at the Children's Kidney Care Center, St. John's Medical College Hospital, Bangalore, In- dia. A total of 50 children received acute dialysis therapy during the period. Of those 50 children, 36 children received peritoneal dialysis (PD), 7 re- ceived hemodialysis (HD), and 7 received both PD and HD. The male:female ratio was 4:1. The mean age of the children who received PD was 6.7 years (range: 1 month to 15 years), and of those who received HD, 9.2 years (range: 4 - 17 years). Two children were dialyzed for severe metabolic acidosis owing to an inborn error of metabolism. The rest had renal failure: acute renal failure (ARF) in 47.9%; end-stage renal failure (ESRF) in 35.4%; and acute on chronic renal failure in 16.7%. In the cases of acute on chronic renal failure, the main causes for acute worsening of renal function were volume deple- tion and drug nephrotoxicity. The causes of ARF and chronic renal failure (CRF) are depicted in Tables 1 and 2. The main reasons for dialyzing the children were fluid overload (20%), hyperkalemia (14%), severe metabolic acidosis (8%), encephalopathy (18%), and biochemical azotemia (40%). The mean pre-dialysis levels of blood urea and serum creatinine were 204.9 mg/dL and 6.76 mg/dL respectively. Acute PD was performed using acute PD catheters and available standard PD solutions containing 1.5% dextrose. The volume of dialysate infused per cycle