by Dr. Stefano Picca, nephrologist at Aventino Medical Group, Rome
When the kidneys become ill and stop working, life is at risk. Not all kidney diseases are irreversible (Chronic Kidney Disease – CKD). When kidney damage is reversible (Acute Kidney Injury – AKI), renal function often needs to be temporarily replaced by dialysis (blood purification) while awaiting recovery.
Dialysis can be performed by drawing blood from a patient’s vessel and passing it through a machine that “cleans” it (hemodialysis) or through a catheter placed in the abdomen between the intestinal loops. The abdomen is periodically filled and drained with a sterile solution that purifies the blood flowing in the abdominal cavity (peritoneal dialysis – PD). The latter is simpler to implement, less expensive, and is the dialysis modality recommended in low‑income countries.
A Decisive Encounter
In 2013, I had the opportunity to meet Professor Mignon McCulloch during a conference. She was the head of the Pediatric Nephrology Department at the Red Cross Children’s Hospital in Cape Town, South Africa. She was running (and still runs) the largest educational program for the diagnosis and treatment of pediatric AKI with dialysis in Africa.
I came from a personal experience developed in a “high‑technology” context at the Bambino Gesù Pediatric Hospital in Rome, surrounded by sophisticated machines, cutting‑edge electronic devices, and numerous specialized collaborators.
I was simply astonished when I heard the question:
“How can you save from death a patient with AKI when you have no material, no trained personnel, and very little time left?”
It sounded to me like the ultimate challenge. With her sponsorship, I became an Educational Ambassador of the ISN and began traveling to French‑ and English‑speaking African countries to teach PD.
The “Saving Young Lives” Initiative
The training was part of the Saving Young Lives (SYL) initiative of the ISN. It consists of adapting non‑dedicated material for PD and training inexperienced doctors and nurses in its implementation.
For example:
- Instead of specific PD catheters, urinary or drainage tubing can be adapted and placed in the patient’s abdomen, working very well.
- Dedicated sterile solutions can be replaced by simple saline solutions enriched with other vital components such as electrolytes or glucose.
An Enriching Experience
About 200 doctors and nurses have been trained during my activity in South Africa, Côte d’Ivoire, Senegal, Gabon, Algeria, and Cameroon.
Outside Africa, I have also been invited to Haiti and India.
On a personal note: I have had a long career, full of satisfactions, but without a doubt, this was the most rewarding choice of my entire working life.
Results
Doctors and nurses trained by the SYL program have treated more than 500 patients using PD, achieving a 65% survival rate.
“A catheter can save a life.”