Dyslipidemia among Sudanese Children Undergoing Maintenance Dialysis

Introduction: Dyslipidemia is an established risk factor for atherosclerosis and cardiovascular disease. It is common among children undergoing maintenance dialysis. To our knowledge, this is the first report on the lipid profile of children undergoing maintenance hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) in Sudan. Methods: We studied 17 children on HD, 11 children on CAPD and 28 controls. The levels of total cholesterol (TC), triglycerides (TGD) and high density lipoprotein cholesterol (HDL-C) were measured from fasting serum samples using electrophoresis and low density lipoprotein cholesterol (LDL-C) was then calculated. Results: End stage renal failure (ESRF) children had higher mean TC (193±36 versus 135±17 mg/dl), higher mean TGD (120±38 versus 90±15 mg/dl), higher mean LDL-C (129±32 versus 69±18 mg/dl), and lower mean HDL-C (39±12 versus 49±4 mg/dl) than controls (P=0.00 for all parameters). CAPD patients had higher mean TC (211±39 versus 181±30 mg/dl) and higher LDL-C (145±35 versus 118±25 mg/dl) than controls (P=0.03 for both parameters). The prevalence of dyslipidemia among ESRF patients was 75% while none of the control group had lipid parameters outside the accepted range. Among ESRF patients, 39.3% had TC > 200 mg/dl, 21.4% had TGD > 150 mg/dl, 42.9% had LDL-C > 130 mg/dl, and 35.7% had HDL-C < 35 mg/dl. Abnormal HDL-C values were more prevalent among CAPD patients compared to HD patients (52.9% versus 9.1%, P=0.02) Conclusion: Despite the small number of studied children, this study is likely to reflect the high prevalence of dyslipidemia among children undergoing maintenance dialysis treatment in Sudan. Keywords: Children; Continuous Ambulatory Peritoneal Dialysis; Dyslipidemia; Hemodialysis; Suda

Non-infectious Complications of Peritoneal Dialysis among Sudanese Patients: Five Years Experience

Introduction: The technique of Continuous Ambulatory Peritoneal Dialysis (CAPD) is known to be associated with various infectious and non-infectious complications. The latter term includes anatomical/mechanical complications as well as hemoperitoneum, inflow pain, electrolyte disturbances, metabolic derangements and delayed gastric emptying. Methods: We retrospectively evaluated all patients who were maintained on CAPD for a minimum of 90 days in Sudan, in the period between May 2005 and Apr 2010. We examined the incidence of various non-infectious complications and their possible associations. Results: The analysis included 296 patients including 71 children (24%). Males constituted 62.2% of the study population and 13.9% were diabetic. The incidence per 100 patient-years of various non-infectious complications was as follows: hypokalemia (30.4), catheter dysfunction (10.8), dialysate leak (5.3), hernia (4.7), hemorrhagic effluent (4.7), inflow pain (2.3), upper gastrointestinal symptoms (2) and cuff extrusion (0.9). Catheter block and hernia were diagnosed with a median duration after catheter insertion of 6 and 7.5 months, respectively. Catheter block was significantly more prevalent among children (22.5% versus 9.3%; P = 0.006). A high body mass index (BMI) was the only identified independent predictor for leak (OR 1.4, P = 0.005). More than half of the 16 hernias were umbilical, and four of the five inguinal hernias were bilateral. Non-infectious complications were responsible for 32% of technique failures. Conclusion: Non-infectious complications were fairly common among our CAPD patients and led to catheter removal in a considerable number of patients. Care is, therefore, needed to screen CAPD patients for these complications in order to timely address and manage problems. Keywords: Peritoneal Dialysis; Non-infectious Complications; Sudan; Herni