Infant receiving peritoneal dialysis, symbolizing hope and healing.

Peritoneal Dialysis in Infants: A Lifeline for Tiny Patients

Soraya Malik in Health & Wellness November 2026 • 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.

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Latest Research

Research on Dialysis and Cognition

A Nature Reviews Nephrology listing dated April 24, 2025, describes authors considering how dialysis treatment, including hemodialysis and peritoneal dialysis, may relate to accelerated cognitive impairment in people with kidney failure. The listing says dialysis has been implicated; it does not establish causation. The snippet does not provide infant-specific findings.

Counterpoints

Limits in Infant Outcome Data

An infant dialysis outcomes study notes that it could not control for unmeasured confounders absent from the Registry database and had missing data, including comorbid conditions. In the Italian Registry study, growth analysis included only infants with complete auxological parameters at 0, 6, and 12 months of follow-up. These limitations are relevant when interpreting the reported outcomes and growth data.

Comparison

Peritonitis Rates in Infants

The SCOPE collaborative report examined peritonitis following maintenance peritoneal dialysis catheter placement during infancy. It reported an in-hospital annualized rate of 1.73 episodes per patient-year and an overall annualized rate of 0.76 episodes per patient-year. The report distinguishes these as in-hospital and overall rates.

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.

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Expert View

Residual Kidney Function

A meta-analysis on peritoneal dialysis describes residual kidney function as affecting patients’ survival and quality of life, and says it examined risk and protective factors associated with its decline. A 2026 narrative review likewise calls residual kidney function important to outcomes, citing its contributions to solute clearance, volume regulation, reduced inflammation, and improved survival. That review also reports that residual kidney function commonly declines after peritoneal dialysis begins and that potentially modifiable factors may contribute.

Broader Context

Challenges in Peritoneal Dialysis

A 2017 review says that, despite gradual global growth in peritoneal dialysis use, several areas need attention and improvement. It identifies technique failure and sustaining long-term treatment as challenges, alongside managing and preventing peritoneal infections. The review also lists malnutrition, inflammation, and cardiovascular issues among areas requiring attention.

Real-World Impact

Outcomes Across Countries

A global study published in 2024 describes kidney failure treated with hemodialysis or peritoneal dialysis as a major health problem associated with increased risks of death and hospitalization. It aimed to compare the incidence and causes of death and hospitalization during the first year of either treatment across countries. The provided description focuses on country-level comparisons rather than infant-specific outcomes.

What infant complication patterns suggest

The comparisons suggest that complication patterns differ by age and by remaining kidney function: catheter-related events were similar across age groups, while clinical complications and peritonitis showed less favorable rates in the younger or oligoanuric groups. These registry comparisons describe associations, not proof that age or kidney function caused the differences.^[1]

Growth was associated with exchange volume and session length, and negatively associated with peritonitis cases. These observations do not establish that changing any one factor would cause a growth change.^[1]

Repeated catheter complications can injure and scar the peritoneal membrane, potentially reducing dialysis effectiveness and leading to membrane failure. The nutrition source explains why disrupted intake can affect infant growth, particularly during early infancy.^{[2] [3]}

How the infant reports compare in scope

The Italian Registry comparison places infant peritonitis rates against older children in the same registry, while the Polish report compares an infant cohort with all children receiving PD in that country. Because the comparison groups differ, the rates should not be read as a direct ranking of the two reports.^{[1] [4]}

Sources

Peritoneal dialysis in infants: the experience of the Italian Registry of Paediatric Chronic Dialysis. (pubmed.ncbi.nlm.nih.gov)
Peritoneal dialysis catheter outcomes in infants initiating peritoneal dialysis for end-stage renal disease (pmc.ncbi.nlm.nih.gov)
Nutritional management of the infant with chronic kidney disease stages 2–5 and on dialysis (pmc.ncbi.nlm.nih.gov)
Successes and pitfalls of chronic peritoneal dialysis in infants – a Polish nationwide outcome study (pmc.ncbi.nlm.nih.gov)

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

Everything You Need To Know

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.

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.

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.

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.

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.