Cargando…

Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities

HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations d...

Descripción completa

Detalles Bibliográficos
Autores principales: Raina, Rupesh, Chauvin, Abigail M., Bunchman, Timothy, Askenazi, David, Deep, Akash, Ensley, Michael J., Krishnappa, Vinod, Sethi, Sidharth Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448754/
https://www.ncbi.nlm.nih.gov/pubmed/28557999
http://dx.doi.org/10.1371/journal.pone.0178233
_version_ 1783239619381297152
author Raina, Rupesh
Chauvin, Abigail M.
Bunchman, Timothy
Askenazi, David
Deep, Akash
Ensley, Michael J.
Krishnappa, Vinod
Sethi, Sidharth Kumar
author_facet Raina, Rupesh
Chauvin, Abigail M.
Bunchman, Timothy
Askenazi, David
Deep, Akash
Ensley, Michael J.
Krishnappa, Vinod
Sethi, Sidharth Kumar
author_sort Raina, Rupesh
collection PubMed
description HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability. METHODS: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests. RESULTS: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants. CONCLUSIONS: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world.
format Online
Article
Text
id pubmed-5448754
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-54487542017-06-15 Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities Raina, Rupesh Chauvin, Abigail M. Bunchman, Timothy Askenazi, David Deep, Akash Ensley, Michael J. Krishnappa, Vinod Sethi, Sidharth Kumar PLoS One Research Article HYPOTHESIS: Acute kidney injury (AKI) is a common cause of morbidity and mortality worldwide, with a pediatric incidence ranging from 19.3% to 24.1%. Treatment of pediatric AKI is a source of debate in varying geographical regions. Currently CRRT is the treatment for pediatric AKI, but limitations due to cost and accessibility force use of adult equipment and other therapeutic options such as peritoneal dialysis (PD) and hemodialysis (HD). It was hypothesized that more cost-effective measures would likely be used in developing countries due to lesser resource availability. METHODS: A 26-question internet-based survey was distributed to 650 pediatric Nephrologists. There was a response rate of 34.3% (223 responses). The survey was distributed via pedneph and pcrrt email servers, inquiring about demographics, technology, resources, pediatric-specific supplies, and preference in renal replacement therapy (RRT) in pediatric AKI. The main method of analysis was to compare responses about treatments between nephrologists in developed countries and nephrologists in developing countries using difference-of-proportions tests. RESULTS: PD was available in all centers surveyed, while HD was available in 85.1% and 54.1% (p = 0.00), CRRT was available in 60% and 33.3% (p = 0.001), and SLED was available in 20% and 25% (p = 0.45) centers of developed and developing world respectively. In developing countries, 68.5% (p = 0.000) of physicians preferred PD to costlier therapies, while in developed countries it was found that physicians favored HD (72%, p = 0.00) or CRRT (24%, p = 0.041) in infants. CONCLUSIONS: Lack of availability of resources, trained physicians and funds often preclude standards of care in developing countries, and there is much development needed in terms of meeting higher global standards for treating pediatric AKI patients. PD remains the main modality of choice for treatment of AKI in infants in developing world. Public Library of Science 2017-05-30 /pmc/articles/PMC5448754/ /pubmed/28557999 http://dx.doi.org/10.1371/journal.pone.0178233 Text en © 2017 Raina et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Raina, Rupesh
Chauvin, Abigail M.
Bunchman, Timothy
Askenazi, David
Deep, Akash
Ensley, Michael J.
Krishnappa, Vinod
Sethi, Sidharth Kumar
Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title_full Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title_fullStr Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title_full_unstemmed Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title_short Treatment of AKI in developing and developed countries: An international survey of pediatric dialysis modalities
title_sort treatment of aki in developing and developed countries: an international survey of pediatric dialysis modalities
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448754/
https://www.ncbi.nlm.nih.gov/pubmed/28557999
http://dx.doi.org/10.1371/journal.pone.0178233
work_keys_str_mv AT rainarupesh treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT chauvinabigailm treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT bunchmantimothy treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT askenazidavid treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT deepakash treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT ensleymichaelj treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT krishnappavinod treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities
AT sethisidharthkumar treatmentofakiindevelopinganddevelopedcountriesaninternationalsurveyofpediatricdialysismodalities