MP859PEDIATRIC DIALYSIS PATIENTS IN GHARDAIA

Abstract

INTRODUCTION AND AIMS: End stage renal disease (ESRD) in pediatric population is a major challenge; it causes constant stress and exposes children to high morbidity and mortality. In Algeria, the number of children reaching ESRD increases anuually, they often arrive in the context of the emergency. The epidemiological studies of the pediatric ESRD in Algeria are few, the statistical data are collected but there is no operable national register. The objectives of this study are: Determine the epidemiological characteristics of dialyzed children and Analyze the results of pediatric dialysis METHODS: In this retrospective study, we included all patients under the age of 19 years at the time of the ESRD, living in Ghardaia, 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. RESULT(S): During the period from 01/01/2005 to 31/12/2014, twenty-five (25) children under the age of 19 years have reached the ESRD and have been dialyzed in different Adult hemodialysis centers in Ghardaia or at home (peritoneal dialysis). The average age was 12 years (1 - 19), sex ratio (M / F) was 0.9. Inbreeding was not frequent, as was prematurity or birth hypotrophy (8%). There is a not inconsiderable proportion of family cases of CKD (04 family / 22), with at least 02 patients per family. The calculated annual incidence of ESRD in the pediatric population in Ghardaia 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%), which is found in studies across the world. Glomerular nephropathies remain the leading cause of pediatric ESRD in our study (36%) which is comparable to most of the series published in Europe, Maghreb or Middle East. 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; this is mainly due to delayed diagnosis. Dialysis was in most cases urgent (68%), patients often arrived with symptomatic uremic syndrome and sometimes consciousness disorder (20%), 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%) CONCLUSION(S): 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.