Infant receiving peritoneal dialysis, symbolizing hope and healing.

Peritoneal Dialysis in Infants: A Lifeline for Tiny Patients

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Soraya Malik in Health & Wellness June 2025 • 4 min read.

"Exploring the long-term survival and challenges of peritoneal dialysis in children under two."


Chronic kidney disease (CKD) in infants presents unique challenges, with peritoneal dialysis (PD) often serving as the primary treatment method. PD offers several advantages, including the ability to be performed at home, preserving residual kidney function, and granting greater autonomy for both the child and their family. This approach is favored over hemodialysis, which can be more difficult to manage in young children due to vascular access issues and the need for specialized centers.

While CKD in the first two years of life is rare, it necessitates specialized care. Recent data from the European Society for Paediatric Nephrology (ESPN) indicates a prevalence of 20.6 per million children under four years of age. Infants undergoing PD represent a significant portion of the pediatric dialysis population, facing a higher risk of complications such as peritonitis and catheter-related infections.

This article delves into a retrospective study examining the long-term outcomes of infants who began PD before their second birthday. The study analyzes survival rates, growth patterns, and developmental milestones, offering insights into the effectiveness and challenges of this life-sustaining treatment. The goal is to provide families and healthcare professionals with a comprehensive understanding of PD in infants, empowering them to make informed decisions and optimize care strategies.

What are the main challenges and outcomes of peritoneal dialysis in infants?

Infant receiving peritoneal dialysis, symbolizing hope and healing.

A retrospective study conducted at a Portuguese pediatric nephrology unit between 1991 and 2014, sheds light on the experiences of 20 infants who initiated PD before the age of two. The study evaluated various factors, including the causes of kidney failure, mortality rates, complications, growth patterns, and psychomotor development.

The findings revealed that congenital abnormalities of the kidneys and urinary tract were the leading cause of chronic kidney failure in this group (45%). The average age at the start of PD was 6.1 months, with a significant number of infants starting treatment within the first month of life. While there were six deaths during the study period, no deaths occurred in children with primary kidney disease in the last decade.

  • Peritonitis: The most frequent cause of hospitalization, highlighting the ongoing challenge of infection control in PD.
  • Growth Impairment: Children remaining on PD experienced stunted growth, underscoring the need for optimized nutritional strategies.
  • Kidney Transplantation: Ten children successfully underwent kidney transplantation at an average age of 5.3 years, demonstrating the potential for long-term survival and improved outcomes.
  • Developmental Delays: A significant proportion (64%) exhibited neurodevelopmental delays, indicating the complex interplay between kidney disease and overall development.
The study emphasizes that while PD can be successfully initiated even in newborns, allowing survival until kidney transplantation is possible, the associated complications and growth challenges necessitate comprehensive care strategies. These include optimizing nutrition, monitoring growth, and addressing developmental needs.

Looking Ahead: Optimizing Care and Improving Outcomes

This research reinforces the value of PD as a viable option for infants with kidney failure, even from birth. However, it also underscores the critical need for ongoing research and development to minimize complications, promote healthy growth, and support neurodevelopment. By focusing on these key areas, healthcare professionals can improve the long-term outcomes and quality of life for these vulnerable patients.

About this Article -

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Everything You Need To Know

1

What is peritoneal dialysis and what are the main issues with using it for infants?

Peritoneal dialysis (PD) is a treatment used for infants with kidney failure, offering advantages like at-home administration and preservation of kidney function. However, challenges include a higher risk of peritonitis, catheter-related infections, and potential developmental delays. While PD enables survival and eventual kidney transplantation, optimizing nutrition and addressing developmental needs are critical for improving outcomes.

2

Why is peritoneal dialysis preferred over other treatments like hemodialysis for infants with kidney failure?

Peritoneal dialysis is favored for infants with chronic kidney disease because it can be administered at home, preserving any remaining kidney function, and offering more autonomy for the child and their family. Hemodialysis, an alternative, is more challenging due to vascular access issues and the requirement for specialized centers, making PD a more practical and manageable option for infants.

3

What usually causes kidney failure in infants who need peritoneal dialysis?

The leading causes of kidney failure in infants undergoing peritoneal dialysis are congenital abnormalities of the kidneys and urinary tract. A study showed that this was the primary cause in 45% of the infants studied. Early initiation of PD is often necessary, with many infants starting treatment within their first month of life to manage this condition.

4

Why do infants on peritoneal dialysis often have problems with growth?

Growth impairment is a significant concern for infants on peritoneal dialysis due to the complex interplay between kidney disease, nutritional needs, and overall development. Addressing growth impairment requires optimized nutritional strategies, careful monitoring, and potential interventions to support healthy development during PD treatment. This is a common complication that needs careful management.

5

How does kidney transplantation relate to peritoneal dialysis in infants, and why is it important?

Kidney transplantation is a crucial long-term goal for infants undergoing peritoneal dialysis. It offers the potential for improved outcomes and a better quality of life. In a study, ten children successfully underwent kidney transplantation at an average age of 5.3 years. Successful transplantation depends on careful monitoring, management of complications, and ensuring the child is a suitable candidate for the procedure.

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