ESPN 50th Annual Meeting

ESPN 2017


 
PEDIATRIC DIALYSIS PATIENTS IN A SOUTHERNE CITY OF ALGERIA
MESSAOUD HADJ MAHAMMED 1

1- CENTRAL HOSPITAL OF GHARDAIA
 
Introduction:

 End stage renal disease (ESRD) in pediatric population is a major challenge. In Algeria, the number of children reaching ESRD increases anuually. The epidemiological studies of the pediatric ESRD in Algeria are few. The objectives of this study are: Determine the epidemiological characteristics of dialyzed children and Analyze the results of pediatric dialysis

Material and methods:

In this retrospective study, we included all patients under the age of 19 years at the time of the ESRD, living in Ghardaïa, purified at least 03 months by hemodialysis (HD) or peritoneal dialysis (DP) during the period of ten (10) years: 01/01/2005 to 31/12/2014. Information was collected from the medical files, interrogation of patients and their parents.

Results:

During the period of study, twenty-five (25) children under the age of 19 years have reached the ESRD and have been dialyzed.The average age was 12 years (1 - 19), sex ratio (M / F) was 0.9. The calculated annual incidence of ESRD in the pediatric population in Ghardaïa was: 15.28 pmarp / yr (Per million age related population). The prevalence is : 73.36 pmarp. The frequency was high for patients between 10 and 14 years of age (44%). Glomerular nephropathies remain the leading cause of pediatric ESRD in our study (36%). The cortico-resistant nephrotic syndrome (6 cases) is the chief of wire but renal biopsy was rarely practiced (2/6) likewise for the genetic study (2/6). Congenital malformations of the kidneys and the excretory pathwurinary tract (CAKUT) are frequent, dominated by obstructive uropathies (neurological bladder) followed by vesico-ureteral reflux.In 20% of the cases, the etiology was not found.

Dialysis was in most cases urgent (68%), anemia was predominantly present at the time of dialysis ( 88%) and transfusion was necessary in 64% of cases . Hemodialysis is the first treatment method for incident (76%) and prevalent (70%) patients in our series.

A very high mortality rate (20%) was founded mainly due to dialysis insufficiency, a very low school enrollment (40%) and a significant retardation of growth (60%). none of our patients was regularly followed in pediatrics during years of dialysis and none of patients benefited from treatment with growth hormone.

The transplant rate (4%) is well below the national average (20%), Only 1 patient has been transplanted, obstacles to kidney transplantation are numerous, mainly the absence of donor (58%)

Conclusions:

Our study is the first work on ESRD of the child in southern Algeria; we have highlighted the following problems:- Late diagnosis of kidney disease- Absence of targeted screening programs- Lack of coordination among practitioners- lack urological surgery for complex CAKUT- Absence of genetic diagnosis in (CRNS, Oxalose, Nephronophtisis ... ..) A comprehensive management of the dialyzed child should enable them to achieve acceptable growth, good schooling and quality of life, require a good training of health care workers and close collaboration between the different treatment practitioners.