Home Dialysis is a Viable Option for Treatment of Young Infants with End Stage Renal Disease in Pakistan

Though renal transplant is preferred mode of renal replacement therapy (RRT), peritoneal dialysis (PD) is an important modality of treatment for children with end stage renal disease (ESRD) but it is underutilized in Pakistan despite several advantages over haemodialysis (HD). The burden of paediatric chronic kidney disease (CKD) and ESRD is under reported, since majority of children (24-63%) present with acute on chronic kidney disease often complicated by multiple co-morbid conditions which may result in death before consideration of long term RRT. In Pakistan, the available care of ESRD/CKD is exclusively hospital based rather than home based dialysis. Manual PD is used as first line option of treatment for acute kidney injury (AKI) or acute on CKD at few centers and long term maintenance PD is not offered at all as first line option of treatment for children with ESRD. Generally, long term PD is less expensive than HD or at least as expensive as HD. This holds true even for most of the developed countries using automated cycler machines but scenario in developing countries like Pakistan is quite different. HD is the only option offered to older children for short period and very few of them become successful to get a renal transplant. Home dialysis or Continuous Ambulatory PD (CAPD) may be the only option to treat young infants to make them free of complications of uraemia and provide adequate nutrition for growth till either HD or transplant become possible. This may be possible once paediatric and adult nephrologists as well as pediatricians recommend and advocate this option for survival of children with ESRD. Furthermore, we need to strengthen the existing RTT facilities and develop more paediatric peritoneal dialysis centers; local production of dialysis fluid and disposables or government should allow free import of PD equipments and solutions. This will not be possible without efforts of all of us including professionals, dialysis nurses or technicians, media persons, pharma industry and community workers as well as parents.