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Abstract

Abstract Background : Infants requiring chronic peritoneal dialysis (PD) remain at high risk of mortality and dialysis-related complications. We compared long-term outcomes of infants initiating maintenance PD with those of temporally aligned older-child controls. Methods : This retrospective single-center study included 45 children who initiated maintenance PD before 12 months of age and 45 temporally aligned controls. Clinical outcomes, PD-related complications, kidney transplantation, mortality, and five-year patient survival were compared. Exploratory analyses within the infant cohort evaluated survival by primary kidney disease and temporal changes in mortality. Results : Infants had higher all-cause mortality than controls (35.6% vs. 2.2%, p <0.001), with five-year survival of 59.5% versus 97.7% ( p <0.001). Peritoneal dialysis-associated peritonitis (PD peritonitis) and catheter failure rates were higher in infants ( p =0.007 and p <0.001, respectively), whereas other PD-related complications did not differ between groups. During follow-up, 51.1% of infants and 66.7% of controls underwent kidney transplantation ( p =0.13), and time from PD initiation to kidney transplantation did not differ between groups. Within the infant cohort, survival was better in patients with CAKUT than in those with non-CAKUT kidney disease ( p =0.012), and crude mortality was lower in the contemporary era ( p =0.018). Conclusions : Infants initiating maintenance PD had substantially poorer five-year survival and higher peritonitis and catheter failure rates than temporally aligned controls. Nevertheless, transplantation was achieved in more than half, supporting PD as a viable bridge through this high-risk period. Exploratory findings further suggest that prognosis in infancy may vary according to underlying kidney disease and improve with contemporary care.