Dialysis therapy in children.

Acute dialysis can be life saving for children suffering from acute emergencies due to acute renal failure, poisoning or inborn errors of metabolism causing severe organic acidaemia and hyperammonaemia. Chronic dialysis is life sustaining for children with chronic renal failure or end stage renal disease till renal transplantation is performed. The basic principles, indications, procedures, equipment, complications of acute and chronic dialysis in children are same as in adults. Dialysis can be performed in children at any age from newborn to adolescent period. In newborn, infants and preschool children (0-5 years age) haemodialysis is difficult due to technical problems associated with vascular access and haemodynamic instability. Peritoneal dialysis is simple, efficient, easy to perform, does not require highly sophisticated equipment or personnel and with low complication rate. For successful dialysis appropriate sizes of catheters, tubings, dialysers, small volume dialysate bags, etc, are required. These are now available in our country, although the cost of peritoneal dialysis fluid and catheters, etc, is 2-3 times higher than equipment for haemodialysis. Hence, continuous ambulatory peritoneal dialysis for chronic renal failure/end stage renal disease has not taken off yet in India. A team of experts including specially trained paediatric nephrologists, urologists, nurses, dieticians, technicians and social workers are needed to organise dialysis programme for children with end stage renal disease. Acute peritoneal dialysis should be made available in each paediatric department offering emergency services to children.