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Wasik HL, Keswani M, Munshi R, Neu A, Richardson T, Warady B. Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis. Pediatr Nephrol 2023; 38:4119-4125. [PMID: 37421469 DOI: 10.1007/s00467-023-06076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD. METHODS We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis. RESULTS There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64-9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90-11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23-13.11, p = 0.59). CONCLUSIONS PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Heather L Wasik
- Division of Pediatric Nephrology, SUNY Upstate Medical University, Physicians' Office Building 805, 725 Irving Avenue, Syracuse, NY, 13210, USA.
| | - Mahima Keswani
- Division of Pediatric Nephrology, Ann and Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | - Raj Munshi
- Division of Pediatric Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Alicia Neu
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Bradley Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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Patry C, Fichtner A, Höcker B, Ries M, Schmitt CP, Tönshoff B. Missing trial results: analysis of the current publication rate of studies in pediatric dialysis from 2003 to 2020. Pediatr Nephrol 2023; 38:227-236. [PMID: 35460394 PMCID: PMC9747852 DOI: 10.1007/s00467-022-05553-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Decision-making in the field of pediatric dialysis requires evidence from clinical trials, but, similar to other fields of pediatric medicine, might be affected by a low trial publication rate. METHODS We analyzed the current publication rate, the time to publication, and factors that might be associated with both rate of and time to publication in pediatric dialysis studies registered as completed on ClinicalTrials.gov from 2003 until November 2020. RESULTS Fifty-three respective studies were identified. These enrolled 7287 patients in total. 28 of 53 studies (52.8%) had results available. We identified a median time to publication of 20.5 months (range, 3-67). Studies published after the FDA Amendments Act establishment in 2007 were published faster (P = 0.025). There was no trend toward a higher publication rate of studies completed more recently (P = 0.431). 26 of 53 studies (49.1%) focused on medication and control of secondary complications of kidney failure. 12 of 53 studies (22.6%) enrolled only children, were published faster (P = 0.029) and had a higher 5-year publication rate (P = 0.038) than studies enrolling both children and adults. 25 of 53 studies (47.1%) were co-funded by industry. These were published faster (P = 0.025). CONCLUSIONS Currently, only 52.8% of all investigated studies in pediatric dialysis have available results, and the overall median time to publication did not meet FDA requirements. This might introduce a publication bias into the field, and it might negatively impact clinical decision-making in this critical subspecialty of pediatric medicine. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Christian Patry
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany.
| | - Alexander Fichtner
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Britta Höcker
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Markus Ries
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Claus Peter Schmitt
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, Heidelberg, Germany
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3
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Kenan BU, Büyükkaragöz B, Leventoğlu E, Bakkaloğlu SA. Eosinophilic peritonitis in children undergoing maintenance peritoneal dialysis: A case report and literature review. Semin Dial 2022; 35:548-555. [PMID: 35788998 DOI: 10.1111/sdi.13113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/10/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022]
Abstract
Eosinophilic peritonitis (EP) constitutes a significant number of culture-negative peritonitis cases that can affect 16-60% of the patients who are treated with maintenance peritoneal dialysis (PD). Although it is mainly considered to be the hypersensitivity response of the peritoneum to foreign substances, it can also develop following culture-positive peritonitis attacks. Besides the presence of more than 100 white blood cells (WBC)/ml, the diagnosis is made with the high number of eosinophils in the dialysate fluid (>10%), usually accompanied by peripheral eosinophilia. In this study, a 12-year-old male patient, who was diagnosed as EP as early as in the first week of PD catheter placement and treated with systemic antihistamines was reported. Additionally, clinical aspects and treatment modalities of EP are presented with a detailed literature review. Although EP is usually a self-limiting clinical manifestation with a benign outcome, it can be overlooked due to the lack of a routine reporting of the count and percentage of peritoneal eosinophils in most centers. For this reason, a detailed examination in culture-negative peritonitis cases for EP in order to avoid unnecessary antibiotic use for these patients should be the strategy.
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Affiliation(s)
| | | | - Emre Leventoğlu
- Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
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Akbalık Kara M, Pınarbaşı AS, Çelik M. Peritoneal dialysis for term neonates in a neonatal intensive care unit. Pediatr Int 2022; 64:e15155. [PMID: 35616157 DOI: 10.1111/ped.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the indications, complications, and outcomes of peritoneal dialysis (PD) in term neonates from a state hospital. METHODS The demographic, clinical, and laboratory data of 67 newborn term infants who underwent PD within the first 4 weeks of life between June 2014 and June 2019 were retrospectively analyzed. RESULTS Twenty-five patients (37.3%) were male, 42 (63.7%) were female. The mean gestational age was 38.3 ± 0.8 (range: 37-40) weeks and mean birthweight 3,100 ± 504.9 g (range: 1,800-5,000 g). The mean age of patients at the start of dialysis was 7.97 ± 8.34 days (range:1-44 days) and the mean duration for dialysis was 3 ± 5.42 days (range 1-40 days). The majority of patients who underwent PD had inborn error of metabolism (59.7%). The most common complication was dialysate leakage. Thirty-three neonates (49.2%) died during PD process because of underlying disease, 17 patients (25.4%) were referred to other centers, and 17 patients (25.4%) were discharged. There were seven acute kidney injury patients associated with hypernatremic dehydration. There were statistically significant differences between non-survivors and survivors in terms of dialysis duration, birthweight, weight at admission, requirements for mechanical ventilation, and inotrop agent, and also the renal angina index. CONCLUSIONS In our region, hypernatremic dehydration is still a one of the major cause for acute kidney injury (AKI) in newborns. In state hospitals, pediatric specialists must be present in neonatal intensive care units in order not to refer unstable patients to other centers and to provide high-quality patient care.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Muhittin Çelik
- Department of Neonatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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5
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AlZabli SM, Alsuhaibani MA, BinThunian MA, Alshahrani DA, Al Anazi A, Varghese S, Rose V, Rahim KA. Peritonitis in children on peritoneal dialysis: 12 years of tertiary center experience. Int J Pediatr Adolesc Med 2021; 8:229-235. [PMID: 34401447 PMCID: PMC8356114 DOI: 10.1016/j.ijpam.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 10/27/2022]
Abstract
Background and Objective Peritoneal dialysis (PD) associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients undergoing PD. We aimed to identify the incidence, pathogens, antibiotic susceptibility, and the outcome of peritoneal dialysis (PD)-associated peritonitis in children. Methods Data from medical records of children who underwent PD between 2007 and 2018 in King Fahad Medical City were retrospectively collected. All children aged <14 years undergoing chronic PD were included. The demographic characteristics of patients, peritonitis rates, and clinical outcomes were collected. Results In total, 131 children [boys, 68 (51.9%)] underwent automated PD for 305 years. The most common age group was 6-12 years (61 patients, 46.6%). A total of 74.0% of patients were new to dialysis; 25.2% were transferred from hemodialysis. Peritonitis incidence was 0.6 episodes/patient-year. Gram-positive and -negative organisms were identified in 50.1% and 22% episodes, respectively, whereas cultures remained negative in 20.5% episodes. Coagulase-negative Staphylococcus was the most common isolated organism (22.1%), followed by methicillin-sensitive S. aureus (11.1%). Peritonitis was resolved in 153 (73.6%) episodes, whereas 52 (25.0%) episodes required removal through the catheter. The multivariate logistic regression analysis found the exit site infection to be a risk factor for catheter removal. Three (1.4%) episodes caused death due to peritonitis complicated by septic shock. Conclusions Our data showed that the most common organisms causing peritonitis were similar to those reported in the previous international registry. The rate of peritonitis was high, but markedly improved in the past two years.
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Affiliation(s)
- Saeed M AlZabli
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Mohammed A Alsuhaibani
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, 51452, Saudi Arabia
| | - Meshail A BinThunian
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Dayel A Alshahrani
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Abdulkarim Al Anazi
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Sibi Varghese
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Vernice Rose
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Khawla A Rahim
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
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Ito Y, Ryuzaki M, Sugiyama H, Tomo T, Yamashita AC, Ishikawa Y, Ueda A, Kanazawa Y, Kanno Y, Itami N, Ito M, Kawanishi H, Nakayama M, Tsuruya K, Yokoi H, Fukasawa M, Terawaki H, Nishiyama K, Hataya H, Miura K, Hamada R, Nakakura H, Hattori M, Yuasa H, Nakamoto H. Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of the Japanese Society for Dialysis Therapy). RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.
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Opportunities for Improvement in Quality of Care of PD-Related Peritonitis in Children. Clin J Am Soc Nephrol 2021; 16:191-193. [PMID: 33462086 PMCID: PMC7863660 DOI: 10.2215/cjn.19461220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Chiu MC, Tong PC, Lai WM, Lau SC. Peritonitis and Exit-Site Infection in Pediatric Automated Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080802803s33] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We reviewed 30 patients in an automated peritoneal dialysis (APD) program from 2002 to 2006 for peritonitis. Patients were 11.6 ± 5.5 years old at initiation of peritoneal dialysis (PD) and had a total of 976 PD months. The overall peritonitis rate was 1 episode in 54.2 patient– months, for a rate of 0.22 episode annually. The rate was considered low, which other than being an APD program, may be attributed to adherence to guidelines and in-charge nurse policy. A total of 17 episodes of peritonitis were identified in 9 patients, and the distribution of patient-specific peritonitis incidence appeared bimodal: 87% patients had no or only 1 episode of peritonitis, and 4 patients accounted for 12 episodes, with an average peritonitis rate of 1.0 annually. Causative organisms included Staphylococcus aureus, coagulase-negative Staphylococcus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, enterococci, alpha-hemolytic Streptococcus. Five episodes had concurrent exit-site infection with the same organism. During the same period in these 30 patients, 40 episodes of exit-site infection (ESI) were recorded in 23 patients. The overall ESI rate was 1 episode in 24.4 PD months. S. aureus and Pseudomonas aeruginosa were the two most common pathogens, accounting for 70% of the infections. Nasal carriage of MRSA was found in 4 patients, and MRSA ESIs in 2. The ESI rate was not low as that observed in peritonitis, which may be attributed to the humid climate.
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Affiliation(s)
- Man-Chun Chiu
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Pak-Chiu Tong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Wai-Ming Lai
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
| | - Shing-Chi Lau
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR, PR China
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Prasad N, Rangaswamy D, Patel M, Gulati S, Bhadauria D, Kaul A, Gupta A. Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study from a developing country. Pediatr Nephrol 2019; 34:2389-2397. [PMID: 31468143 DOI: 10.1007/s00467-019-04311-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. METHODS To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. RESULTS A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months). CONCLUSION CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Dharshan Rangaswamy
- Department of Nephrology (Pediatric), Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal (Udupi), 576104, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Sanjeev Gulati
- Pediatric Nephrology, Fortis Group of Hospitals, New Delhi, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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A Clinical Risk Prediction Tool for Peritonitis-Associated Treatment Failure in Peritoneal Dialysis Patients. Sci Rep 2018; 8:14797. [PMID: 30287920 PMCID: PMC6172229 DOI: 10.1038/s41598-018-33196-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/25/2018] [Indexed: 11/08/2022] Open
Abstract
A tool to predict peritonitis-associated treatment failure among peritoneal dialysis (PD) patients has not yet been established. We conducted a multicentre, retrospective cohort study among 1,025 PD patients between 2006 and 2016 in Thailand to develop and internally validate such a tool. Treatment failure was defined as either a requirement for catheter removal, a switch to haemodialysis, or peritonitis-associated mortality. Prediction model performances were analysed using discrimination (C-statistics) and calibration (Hosmer-Lemeshow test) tests. Predictors were weighted to calculate a risk score. In total, 435 patients with 855 episodes of peritonitis were identified; 215 (25.2%) episodes resulted in treatment failure. A total risk score of 11.5 was developed including, diabetes, systolic blood pressure <90 mmHg, and dialysate leukocyte count >1,000/mm3 and >100/mm3 on days 3-4 and day 5, respectively. The discrimination (C-statistic = 0.92; 95%CI, 0.89-0.94) and calibration (P > 0.05) indicated an excellent performance. No significant difference was observed in the internal validation cohort. The rate of treatment failure in the different groups was 3.0% (low-risk, <1.5 points), 54.4% (moderate-risk, 1.5-9 points), and 89.5% (high-risk, >9 points). A simplified risk-scoring scheme to predict treatment failure may be useful for clinical decision making regarding PD patients with peritonitis. External validation studies are needed.
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Kara A, Gurgoze MK, Aydin M, Taskin E, Bakal U, Orman A. Acute peritoneal dialysis in neonatal intensive care unit: An 8-year experience of a referral hospital. Pediatr Neonatol 2018; 59:375-379. [PMID: 29217372 DOI: 10.1016/j.pedneo.2017.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/08/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The aim of present study was to evaluate the indications, complications and outcomes of acute peritoneal dialysis (APD) in neonates at a referral university hospital during the previous 8 years. METHODS This retrospective analysis included a total of 52 newborn infants who underwent APD in a neonatal intensive care unit between January 2008 and March 2016. Demographic, clinical, laboratory and microbiological data were extracted from patients' medical files. RESULTS The primary causes for requiring APD were acute tubular necrosis (n = 36, 69.2%), inborn error of metabolism (n = 10, 19.2%), congenital nephrotic syndrome (n = 2, 3.9%), bilateral polycystic kidney (n = 2, 3.9%), renal agenesis (n = 1, 1.9%), and obstructive uropathy (n = 1, 1.9%). The mean duration of APD was 8.7 ± 15.87 days (range: 1-90 days). Procedural complications were mainly hyperglycemia (n = 16, 47.1%), dialysate leakage (n = 7, 20.6%), peritonitis (n = 3, 8.8%), catheter obstruction (n = 3, 8.8%), bleeding at the time of catheter insertion (n = 2, 5.9%), catheter exit site infection (n = 2, 5.9%), and bowel perforation (n = 1 2.9%). There were 40 deaths (76.9%), mainly due to underlying causes. Ten of the 12 survivors showed full renal recovery, but mild chronic renal failure (n = 1) and proteinuria with hypertension were seen (n = 1) in each of remaining patients. CONCLUSION Peritoneal dialysis is an effective route of renal replacement therapy in the neonatal period for management of metabolic disturbances as well as renal failure. Although major complications of the procedure are uncommon, these patients still have a high mortality rate due to serious nature of the underlying primary causes.
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Affiliation(s)
- Aslihan Kara
- Department of Pediatric Nephrology, School of Medicine, Firat University, Elazig, Turkey.
| | - Metin Kaya Gurgoze
- Department of Pediatric Nephrology, School of Medicine, Firat University, Elazig, Turkey
| | - Mustafa Aydin
- Department of Neonatology, School of Medicine, Firat University, Elazig, Turkey
| | - Erdal Taskin
- Department of Neonatology, School of Medicine, Firat University, Elazig, Turkey
| | - Unal Bakal
- Department of Pediatric Surgery, School of Medicine, Firat University, Elazig, Turkey
| | - Aysen Orman
- Department of Neonatology, School of Medicine, Firat University, Elazig, Turkey
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Vidal E. Peritoneal dialysis and infants: further insights into a complicated relationship. Pediatr Nephrol 2018; 33:547-551. [PMID: 29218436 DOI: 10.1007/s00467-017-3857-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 11/24/2017] [Accepted: 11/24/2017] [Indexed: 01/23/2023]
Abstract
Peritoneal dialysis (PD) in infants represents one of the greatest challenges for pediatric nephrologists. Over recent years, positive outcome data described by several multicenter experiences and registry studies have increased the amount of information available to help determine whether to initiate a dialysis program in this high-risk patient population. There is no doubt that the rigorous implementation of strategies aimed at preventing infectious complications may have contributed to reducing the morbidity rate of these patients. However, the complex nature of infants with end-stage renal disease and the presence of multiple comorbidities still represent hallmarks that significantly impact on outcome. Although the rigorous application of improved scientific techniques can still contribute to enhancing PD results in infants, we have to acknowledge that the severity of illness in infants, especially at dialysis initiation, represents an undeniable and nonmodifiable factor.
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Affiliation(s)
- Enrico Vidal
- Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Woman's and Child's Health, University Hospital of Padua, Via Giustiniani 3, 35128, Padua, Italy.
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Ponce D, de Moraes TP, Pecoits-Filho R, Figueiredo AE, Barretti P. Peritonitis in Children on Chronic Peritoneal Dialysis: The Experience of a Large National Pediatric Cohort. Blood Purif 2017; 45:118-125. [PMID: 29241184 DOI: 10.1159/000484344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We performed this study to evaluate the incidence, risk factors, microbiology, treatment, and outcome of peritonitis in pediatric Peritoneal dialysis (PD) patients at a nationwide prospective study. METHODOLOGY Patients younger than 18 years recruited in the BRAZPD II study from 2004 to 2011, who presented their first peritonitis episode, were included in the study. RESULTS We found 125 first episodes of peritonitis in 491 children PD patients (0.43 episodes/patient-year). Patients free of peritonitis episode constituted 75.6% in 1 year. Culture-negative episodes were very high (59.2%) and gram-positive (GP) bacteria were the most commonly found organisms (58.8%). First-generation cephalosporin was the initial choice to cover GP (40.5%) and aminoglycosides was the most prescribed antibiotics used for gram-negative agents (27.5%). Treatment failure was 26.4%. Technique failure (TF) occurred in 12.1% and peritonitis was the main cause (65.1%). Pseudomonas (p = 0.04) and negative cultures (p < 0.001) were identified as predictors of TF. CONCLUSION Peritonitis remains a common complication of PD in children and negative cultures and pseudomonas had a negative impact on TF.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pasqual Barretti
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
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Is there such a thing as biocompatible peritoneal dialysis fluid? Pediatr Nephrol 2017; 32:1835-1843. [PMID: 27722783 PMCID: PMC5579143 DOI: 10.1007/s00467-016-3461-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 10/31/2022]
Abstract
Introduction of the so-called biocompatible peritoneal dialysis (PD) fluids was based on a large body of experimental evidence and various clinical trials suggesting important clinical benefits. Of these, until now, only preservation of residual renal function-likely due to lower glucose degradation product load and, in case of icodextrin, improved fluid and blood pressure control-have consistently been proven, whereas the impact on important clinical endpoints such as infectious complications, preservation of PD membrane transport function, and patient outcome, are still debated. In view of the high morbidity and mortality rates of PD patients, novel approaches are warranted and comprise the search for alternative osmotic agents and enrichment of PD fluids with specific pharmacologic agents, such as alanyl-glutamine, potentially counteracting local but also systemic sequelae of uremia and PD.
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Dotis J, Myserlis P, Printza N, Stabouli S, Gkogka C, Pavlaki A, Papachristou F. Peritonitis in children with automated peritoneal dialysis: a single-center study of a 10-year experience. Ren Fail 2016; 38:1031-5. [PMID: 27185324 DOI: 10.1080/0886022x.2016.1183256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Peritoneal dialysis (PD) constitutes the preferred dialysis modality for children requiring renal replacement therapy with peritonitis being one of the most common complications of PD. This study was performed to evaluate the epidemiology, microbiology, and outcomes of PD-associated peritonitis in Greek children for a 10-year period. A total of 27 patients (16 males) with a mean age 121.8 ± 57.2 months were retrospective analyzed. Patients were on PD therapy for a mean duration of 45.2 ± 26.1 months. We found 23 episodes of PD-associated peritonitis occurred in 9 out of 27 patients (0.23 episodes/patient-year), with four patients experienced two or more peritonitis episodes. Gram-positive bacteria were responsible for 15 (65.2%) peritonitis episodes, with Staphylococcus aureus being the predominant specie isolated in 30.4% of cases. A total of seven episodes of exit-site infections (ESIs) were identified in five patients (0.069 episodes/patient-year) with the most common bacteria isolated being S. aureus (57.4%). Initial antibiotic treatment included intraperitoneal vancomycin plus ceftazidime in the majority of cases (82.6%). At the end of study, 12 (44.4%) patients remained on PD, 11 (41.8%) underwent renal transplantation, 2 (7.4%) shifted to hemodialysis and unfortunately, two patients (7.4%) died. Conclusively, our study revealed a noticeable low peritonitis and ESIs rate as compared to international data and represents the first evaluation of the characteristics and outcomes of peritonitis in the Greek pediatric PD population.
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Affiliation(s)
- John Dotis
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Pavlos Myserlis
- b Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Nikoleta Printza
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Stella Stabouli
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Chrysa Gkogka
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Antigoni Pavlaki
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Fotios Papachristou
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Ustyol L, Peker E, Demir N, Agengin K, Tuncer O. The Use of Acute Peritoneal Dialysis in Critically Ill Newborns. Med Sci Monit 2016; 22:1421-6. [PMID: 27121012 PMCID: PMC4913833 DOI: 10.12659/msm.898271] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background To evaluate the efficacy, complications, and mortality rate of acute peritoneal dialysis (APD) in critically ill newborns. Material/Methods The study included 31 newborns treated in our center between May 2012 and December 2014. Results The mean birth weight, duration of peritoneal dialysis, and gestational age of the patients were determined as 2155.2±032.2 g (580–3900 g), 4 days (1–20 days), and 34 weeks (24–40 weeks), respectively. The main reasons for APD were sepsis (35.5%), postoperative cardiac surgery (16%), hypoxic ischemic encephalopathy (13%), salting of the newborn (9.7%), congenital metabolic disorders (6.1%), congenital renal diseases (6.5%), nonimmune hydrops fetalis (6.5%), and acute kidney injury (AKI) due to severe dehydration (3.2%). APD-related complications were observed in 48.4% of the patients. The complications encountered were catheter leakages in nine patients, catheter obstruction in three patients, peritonitis in two patients, and intestinal perforation in one patient. The general mortality rate was 54.8%, however, the mortality rate in premature newborns was 81.3%. Conclusions APD can be an effective, simple, safe, and important therapy for renal replacement in many neonatal diseases and it can be an appropriate treatment, where necessary, for newborns. Although it may cause some complications, they are not common. However, it should be used carefully, especially in premature newborns who are vulnerable and have a high mortality risk. The recommendation of APD therapy in such cases needs to be verified by further studies in larger patient populations.
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Affiliation(s)
- Lokman Ustyol
- Department of Pediatrics, Division of Nephrology, Yuzuncu Yil University, School of Medicine, Van, Turkey
| | - Erdal Peker
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University, School of Medicine, Van, Turkey
| | - Nihat Demir
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University, School of Medicine, Van, Turkey
| | - Kemal Agengin
- Department of Pediatric Surgery, Yuzuncu Yil University, School of Medicine, Van, Turkey
| | - Oguz Tuncer
- Department of Pediatrics, Division of Neonatology, Yuzuncu Yil University, School of Medicine, Van, Turkey
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Infectious outcomes following gastrostomy in children receiving peritoneal dialysis. Pediatr Nephrol 2015; 30:849-54. [PMID: 25472828 DOI: 10.1007/s00467-014-2951-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/22/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early institution of enteral feeding in paediatric end-stage kidney disease (ESKD) is recommended. For patients on peritoneal dialysis (PD) there is concern that gastrostomy tube (GT) insertion may be complicated by increased peritonitis, in particular fungal. Our unit favours early planned GT insertion, and for those with late presentation, there is prompt consideration of GT insertion following dialysis initiation. This study evaluates our rates of peritonitis with GT insertion following or concurrent with PD initiation. METHODS This was a retrospective, single-centre, cross-sectional study of of 17 New Zealand children with ESKD who received PD in the period 2000-2011. Inclusion criteria were GT placement while on PD or initiation of PD within 72 h of GT insertion. RESULTS There were no cases of fungal peritonitis among the 17 children; however, two cases of early peritonitis with organisms derived from the gastrointestinal tract were identified. No statistically significant difference was found between incident rates of bacterial peritonitis before GT placement (0.6 episodes per patient-year; 95% confidence interval (CI) 0.26-1.18) and post-GT placement (1.21 episodes per patient-year; 95% CI 0.69-1.97). CONCLUSION Fungal peritonitis has never been encountered by out unit during its many years of experience in GT placement in patients without advanced malnutrition. When children on PD have insufficient dietary intake to maintain appropriate growth velocity, enteral feeding should be initiated promptly. A GT is considered to be safe for long-term use in selected patients.
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Aoun B, Ulinski T, Sanjad S, Termos S, Dahrouj M, Fakhoury H, Schmitt CP. Chronic peritoneal dialysis in Lebanese children of families with low socioeconomic status. Perit Dial Int 2015; 35:93-6. [PMID: 25700461 DOI: 10.3747/pdi.2013.00342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bilal Aoun
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université
| | - Tim Ulinski
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Sami Sanjad
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Salah Termos
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Manal Dahrouj
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Hassan Fakhoury
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
| | - Claus Peter Schmitt
- Armand-Trousseau University Hospital APHP, Department of Pediatric Nephrology, Paris, France Rafic Hariri University Hospital Department of Pediatrics, Beirut, Lebanon American University Hospital Department of Pediatrics, Beirut, Lebanon Rafic Hariri University Hospital Department of general surgery, Beirut, Lebanon Center for Pediatric and Adolescent Medicine University of Heidelberg, Heidelberg, Germany DHU-I2B Inflammation-Immunopathologie-Biothérapie Université Pierre et Marie Curie Paris, France
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Zurowska AM, Fischbach M, Watson AR, Edefonti A, Stefanidis CJ. Clinical practice recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). Pediatr Nephrol 2013; 28:1739-48. [PMID: 23052647 PMCID: PMC3722439 DOI: 10.1007/s00467-012-2300-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 06/28/2012] [Accepted: 07/18/2012] [Indexed: 11/04/2022]
Abstract
BACKGROUND To provide recommendations for the care of infants with stage 5 chronic kidney disease (CKD5). SETTING European Paediatric Dialysis Working Group. DATA SOURCES Literature on clinical studies involving infants with CKD5 (end stage renal failure) and consensus discussions within the group. RECOMMENDATIONS There has been an important change in attitudes towards offering RRT (renal replacement therapy) to both newborns and infants as data have accumulated on their improved survival and long-term outcomes. The management of this challenging group of patients differs in a number of ways from that of older children. The authors have summarised the basic recommendations for treating infants with CKD5 in order to support the multidisciplinary teams who endeavour on this difficult task.
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Affiliation(s)
- Aleksandra M Zurowska
- Department Paediatric & Adolescent Nephrology & Hypertension, Medical University of Gdansk, Ul. Debinki 7, 80-211, Gdansk, Poland.
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20
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Battelino N, Pokorn M, Švent-Kučina N, Križan-Hergouth V, Novljan G. Fulminant Peritonitis Presumably Caused by Panton-Valentine Leukocidin-Positive Staphylococcus aureusin a Girl on Peritoneal Dialysis. Ther Apher Dial 2013; 17:431-7. [DOI: 10.1111/1744-9987.12092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Nina Battelino
- Department of Pediatric Nephrology; University Medical Centre Ljubljana; Ljubljana; Slovenia
| | - Marko Pokorn
- Department of Infectious Diseases; University Medical Centre Ljubljana; Ljubljana; Slovenia
| | - Nataša Švent-Kučina
- Institute of Microbiology and Immunology; Medical Faculty; University of Ljubljana; Ljubljana; Slovenia
| | - Veronika Križan-Hergouth
- Institute of Microbiology and Immunology; Medical Faculty; University of Ljubljana; Ljubljana; Slovenia
| | - Gregor Novljan
- Department of Pediatric Nephrology; University Medical Centre Ljubljana; Ljubljana; Slovenia
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21
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Lee KO, Park SJ, Kim JH, Lee JS, Kim PK, Shin JI. Outcomes of peritonitis in children on peritoneal dialysis: a 25-year experience at Severance Hospital. Yonsei Med J 2013; 54:983-9. [PMID: 23709435 PMCID: PMC3663235 DOI: 10.3349/ymj.2013.54.4.983] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 09/04/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Relatively little is known on the microbiology, risk factors and outcomes of peritoneal dialysis (PD)-associated peritonitis in Korean children. We performed this study in order to evaluate the incidence, treatment and clinical outcomes of peritonitis in pediatric PD patients at Severance Hospital. MATERIALS AND METHODS We analyzed data from 57 PD patients younger than 18 years during the period between June 1, 1986 and December 31, 2011. The collected data included gender, age at commencement of PD, age at peritonitis, incidence of peritonitis, underlying causes of end stage renal disease, microbiology of peritonitis episodes, antibiotics sensitivity, modality and outcomes of PD. RESULTS We found 56 episodes of peritonitis in 23 of the 57 PD patients (0.43 episodes/patient-year). Gram-positive bacteria were the most commonly isolated organisms (40 episodes, 71.4%). Peritonitis developed in 17 patients during the first 6 months following initiation of PD (73.9%). Peritonitis episodes rarely resulted in relapse or the need for permanent hemodialysis and no patient deaths were directly attributable to peritonitis. Antibiotic regimens included cefazolin+tobramycin from the years of 1986 to 2000 and cefazolin+ ceftazidime from the years of 2001 to 2011. While antibiotic therapy was successful in 48 episodes (85.7%), the treatment was ineffective in 8 episodes (14.3%). The rate of continuous ambulatory PD (CAPD) peritonitis was statistically higher than that of automated PD (APD) (p=0.025). CONCLUSION Peritonitis was an important complication of PD therapy and we observed a higher incidence of PD peritonitis in patients with CAPD when compared to APD.
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Affiliation(s)
- Kyong Ok Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Jin Park
- Department of Pediatrics, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Hong Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pyung Kil Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
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Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, Chadha V, Yap HK, Schaefer F. Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 2013; 32 Suppl 2:S32-86. [PMID: 22851742 DOI: 10.3747/pdi.2011.00091] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri 64108, USA.
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Lindley RM, Williams AR, Fraser N, Shenoy MU. Synchronous laparoscopic-assisted percutaneous endoscopic gastrostomy and peritoneal dialysis catheter placement is a valid alternative to open surgery. J Pediatr Urol 2012; 8:527-30. [PMID: 22023847 DOI: 10.1016/j.jpurol.2011.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/28/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gastrostomy feeding is frequently necessary in children receiving chronic peritoneal dialysis (PD). Synchronous laparoscopic-assisted placement of percutaneous endoscopic gastrostomy (PEG) and PD catheter has many potential advantages. This study investigates whether this technique is comparable to open placement. METHODS The notes of all patients over a 16-year time period were reviewed retrospectively. Peritonitis was defined as the presence of a white blood cell count > 100/mm(3) with at least 50% being polymorphonuclear leukocytes, and infection was defined as the presence of positive peritoneal cultures with peritonitis. RESULTS Ten patients received primary laparoscopic-assisted PEG and PD catheter insertion (LAP) and 23 patients open gastrostomy and PD catheter (OPEN). PD catheter survival was median 12 months in the LAP group and 17 months in the OPEN group. Peritonitis and infection rates per catheter-year were 0.89 and 0.7 LAP and 0.59 and 0.5 OPEN. The risk of peritonitis and infection was not related to method of placement. CONCLUSIONS There were no statistically significant differences in outcomes between the two groups. We conclude that laparoscopic-assisted synchronous PD and PEG catheter insertion is safe and effective.
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Affiliation(s)
- R M Lindley
- Department of Paediatric Surgery, Sheffield Children's NHS Trust, Western Bank, Sheffield S10 2TH, UK.
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Dong J, Luo S, Xu R, Chen Y, Xu Y. Clinical characteristics and outcomes of "silent" and "non-silent" peritonitis in patients on peritoneal dialysis. Perit Dial Int 2012; 33:28-37. [PMID: 22855888 DOI: 10.3747/pdi.2011.00236] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES We compared the clinical characteristics and outcomes of "silent" peritonitis (meaning episodes without fever and abdominal pain) and "non-silent" peritonitis in patients on peritoneal dialysis (PD). METHODS Our cohort study collected data about all peritonitis episodes occurring between January 2008 and April 2010. Disease severity score, demographics, and biochemistry and nutrition data were recorded at baseline. Effluent cell counts were examined at regular intervals, and the organisms cultured were examined. Treatment failure was defined as peritonitis-associated death or transfer to hemodialysis. RESULTS Of 248 episodes of peritonitis occurring in 161 PD patients, 20.9% led to treatment failure. Of the 248 episodes, 51 (20.6%) were not accompanied by fever and abdominal pain. Patients with these silent peritonitis episodes tended to be older (p = 0.003). The baseline values for body mass index, triglycerides, and daily energy intake were significantly lower before silent peritonitis episodes than before non-silent episodes (p = 0.01, 0.003, and 0.001 respectively). Although silent peritonitis episodes were more often culture-negative and less often caused by gram-negative organisms, and although they presented with low effluent white cell counts on days 1 and 3, the risk for treatment failure in those episodes was not lower (adjusted odds ratio: 1.33; 95% confidence interval: 0.75 to 2.36; p = 0.33). CONCLUSIONS Silent peritonitis is not a rare phenomenon, especially in older patients on PD. Although these episodes were more often culture-negative, silent presentation was not associated with a better outcome.
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Affiliation(s)
- Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, PR China.
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Dong J, Li Z, Xu R, Chen Y, Luo S, Li Y. Disease severity score could not predict the outcomes in peritoneal dialysis-associated peritonitis. Nephrol Dial Transplant 2012; 27:2496-501. [DOI: 10.1093/ndt/gfr654] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vidal E, Marzollo A, Betto M, Murer L. Automated peritoneal dialysis-related peritonitis due to Salmonella enteritidis in a pediatric patient. Clin Exp Nephrol 2011; 16:342-4. [PMID: 21964761 DOI: 10.1007/s10157-011-0541-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 09/07/2011] [Indexed: 11/30/2022]
Abstract
Peritoneal dialysis (PD) represents the preferred renal replacement therapy in pediatric patients; however, the younger the age at PD initiation, the greater the risk of PD-related infections. We present here the first case report of a 14-year-old girl with automated peritoneal dialysis-related Salmonella enteritidis peritonitis. The child responded only partially to an appropriate course of antibiotic therapy; the PD catheter was therefore removed and the patient shifted to hemodialysis. Along with the clinical course description, we review the mechanisms by which this group of Salmonella could infect the peritoneal cavity in patients on PD. Pediatric nephrologists should be aware that peritoneal catheter removal is often required for the complete resolution of this type of bacterial peritonitis.
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Affiliation(s)
- Enrico Vidal
- Department of Pediatrics, Pediatric Nephrology, Dialysis and Transplantation Unit, University of Padua, Via Giustiniani, 3, 35128, Padua, Italy.
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Schaefer F, Warady BA. Peritoneal dialysis in children with end-stage renal disease. Nat Rev Nephrol 2011; 7:659-68. [PMID: 21947118 DOI: 10.1038/nrneph.2011.135] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Peritoneal dialysis is the preferred chronic dialysis modality for most children owing to its almost universal applicability and superior compatibility with lifestyle over other modalities. Although technological advances and increasing clinical experience have impacted favorably on patient and technique survival, clinical research in pediatric peritoneal dialysis has been hampered by the low incidence of end-stage renal disease (ESRD) in the pediatric population. To overcome this limitation, several international registries have emerged in the past few years to complement other long-standing registries, which together have provided useful information regarding technique-specific complications and comorbidities associated with ESRD in children undergoing chronic peritoneal dialysis. In this Review, we summarize the most relevant findings from these studies, highlighting the substantial variation in patient conditions, peritoneal dialysis practices and management of comorbidities encountered in different parts of the world.
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Affiliation(s)
- Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
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Sebestyen JF, Warady BA. Advances in pediatric renal replacement therapy. Adv Chronic Kidney Dis 2011; 18:376-83. [PMID: 21896380 DOI: 10.1053/j.ackd.2011.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/11/2022]
Abstract
Advances in the understanding and clinical application of hemodialysis, peritoneal dialysis, and continuous renal replacement therapy have resulted in strategies designed to further improve their safety and efficacy. These advances have been particularly important to children, in whom a variety of clinical and technical issues must be taken into consideration for optimum dialysis across a broad spectrum of patient size and need. This manuscript reviews recent data pertaining to the use of renal replacement therapy, with an emphasis on those aspects of dialysis management that are especially pertinent to pediatric ESRD and acute kidney injury care.
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La dialyse péritonéale en réanimation pédiatrique — Indications, principes physiopathologiques, modalités pratiques. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Specialist pediatric dialysis nursing improves outcomes in children on chronic peritoneal dialysis. Pediatr Nephrol 2010; 25:2141-7. [PMID: 20559665 DOI: 10.1007/s00467-010-1581-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/29/2010] [Accepted: 06/02/2010] [Indexed: 10/19/2022]
Abstract
Chronic peritoneal dialysis (PD) for children in Singapore was instituted in 1988 at the National University Hospital with adult nurses providing dialysis services during the first 10 years. In 1998, a specialist pediatric dialysis nursing team was recruited. This study was conducted to determine the impact of dialysis nursing service on PD-related outcomes during the two nursing periods. Comparing the adult (group 1) and pediatric (group 2) nursing periods, the peritonitis rate was significantly higher in group 1 (RR 1.90; 95%CI 1.27-2.84), and this association did not weaken after adjusting for age, gender, and exit site infections. Exit site infection rate (RR 2.16; 95%CI 1.44-3.23), risk of peritonitis during the first year (RR 3.65; 95%CI 1.68-7.90), and multiple peritonitis attacks (RR 2.45; 95%CI 1.32-4.55) were higher in group 1. The peritonitis rates for adult patients cared for by the same adult nurses declined sharply from 1.05 episodes per patient-year between 1989 and 1992 to 0.41 episodes per patient-year between 1995 and 1997, however the corresponding pediatric rates did not change (1.48 to 1.06 episodes per patient-year, respectively) until the second era when specialized pediatric nurses were available. In conclusion, establishment of a specialist pediatric dialysis nursing team resulted in significant improvement in infection-related PD outcomes.
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Bordador EB, Johnson DW, Henning P, Kennedy SE, McDonald SP, Burke JR, McTaggart SJ. Epidemiology and outcomes of peritonitis in children on peritoneal dialysis in Australasia. Pediatr Nephrol 2010; 25:1739-45. [PMID: 20393751 DOI: 10.1007/s00467-010-1510-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 02/23/2010] [Accepted: 02/24/2010] [Indexed: 11/24/2022]
Abstract
Peritonitis is a common complication and major cause of morbidity in children on peritoneal dialysis. In this retrospective longitudinal study, we analysed data retrieved from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) on 167 patients aged less than 18 years of age who were treated with peritoneal dialysis during the period from October 2003 to December 2007. During this period there were 100 episodes of peritonitis in 57 patients (0.71 episodes/patient-year), with Gram-positive organisms most commonly isolated (44%). Peritonitis occurred frequently in the first 6 months after starting dialysis, with survival analysis showing peritonitis-free survival rates of 72%, 56% and 36% at 6 months, 1 year and 2 years respectively. Age was a weak predictor of peritonitis on univariate analysis, but previous peritonitis was the only significant predictor in a multivariate Cox proportional hazards model (adjusted hazard ratio 2.02; 95% CI: 1.20 to 3.40, p = 0.008). Peritonitis episodes infrequently resulted in relapse (5%), recurrence (7%) or the need for either temporary or permanent haemodialysis (5% and 7% respectively) and there were no patient deaths directly attributable to peritonitis. Compared with single organism peritonitis, polymicrobial peritonitis was not associated with any statistically significant differences in outcome. Further prospective studies are required to determine the most appropriate prophylactic measures and antibiotic regimens for use in pediatric patients.
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Affiliation(s)
- Esmeralda B Bordador
- Queensland Child and Adolescent Renal Service, Royal Children's Hospital and Mater Children's Hospitals, Herston Road, 4029 Herston, Brisbane, Queensland, Australia
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Jander A, Makulska I, Latoszyńska J, Boguszewska-Bączkowska H, Bałasz-Chmielewska I, Zagożdżon I, Załuska-Leśniewska I, Stefaniak E, Leszczyńska B, Zachwieja K, Wierciński R, Kipigroch H, Kołłątaj B, Tkaczyk M. Successes and pitfalls of chronic peritoneal dialysis in infants - a Polish nationwide outcome study. Arch Med Sci 2010; 6:414-9. [PMID: 22371780 PMCID: PMC3282521 DOI: 10.5114/aoms.2010.14265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 05/22/2009] [Accepted: 07/23/2009] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Peritoneal dialysis (PD) is a preferred method of renal replacement therapy for end-stage renal disease in children. Recent advances have allowed chronic PD to be provided to children of all ages and sizes. MATERIAL AND METHODS The study was designed as a national (10 dialysis centres), multicentre retrospective analysis of the medical history of 33 children who started chronic peritoneal dialysis in their infancy between 1993 and 2005, with a follow-up period of at least 24 months. RESULTS The nutritional status of the infants was unsatisfactory. The mean SDS of body weight at the start was -2.0, at 1 year of age -1.7. Only 40% of infants were adequately nourished at 1 year of age. Long-term follow-up analysis showed that 12 children received a kidney transplant, 13 were still on dialysis (4 changed method) and 6 died (mortality rate in the first year of life of 9%). In 2 children we observed an improvement of renal function. We observed a relatively high (1/8.8 patient-months) peritonitis rate in the analysed children when compared to 1 : 22 patient-months in all children undergoing PD in Poland. CONCLUSIONS The results of our survey have shown that the management of dialysed infants is still a challenge for the medical team and families, but long-term results of the therapy are encouraging.
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Affiliation(s)
- Anna Jander
- Nephrology Division, Department of Paediatrics and Immunology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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- Nephrology Division, Department of Paediatrics and Immunology, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
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Silverstein DM, Wilcox JE. Outcome of accidental peritoneal dialysis catheter holes or tip exposure. Pediatr Nephrol 2010; 25:1147-51. [PMID: 20157736 DOI: 10.1007/s00467-010-1456-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 01/11/2010] [Accepted: 01/12/2010] [Indexed: 12/01/2022]
Abstract
Pediatric peritoneal dialysis (PD) patients are at risk for acute peritonitis. One risk factor is accidental exposure of the catheter to a non-sterile surface. We studied catheter exposures in 17 pediatric patients receiving PD who developed 16 holes and 12 other accidental exposures. The rate of exposures was 3.7 events/100 patient-months. After exposure, the mean counts (+ or - standard error) of white blood cells (WBC), red blood cells, and neutrophils were 39.8 + or - 19.3, 9.5 + or - 7.1, and 24.2 + or - 5.3/mm(3), respectively. There was a trend towards higher peritoneal fluid WBC in patients with holes than in those with exposures (60.1 + or - 34.8 vs. 15.4 + or - 5.1/mm(3), respectively; p = 0.2). The initial peritoneal fluid WBC count was significantly higher if there was a positive culture than a negative culture (165.0 + or - 132.6 vs. 20.3 + or - 6.4/mm(3), respectively; p = 0.01). The percentage of neutrophils was higher in patients with a positive culture than in those with a negative culture (54.7 + or - 14.1 vs. 19.1 + or - 4.9%, respectively; p = 0.01). Of the 28 patients, 27 received a single dose of intravenous antibiotics, as per the protocol at that time. Among those treated, 7% developed a positive culture (all staphylococcal species) while 93% had a negative culture. We conclude that following accidental exposure of the peritoneal dialysis catheter: (1) the prevalence of peritonitis is low; (2) measuring peritoneal fluid WBC provides treatment guidance; (3) if treatment is initiated, it should be applied intraperitoneally and include activity against Gram-positive organisms.
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Affiliation(s)
- Douglas M Silverstein
- Division of Nephrology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA.
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Sutherland SM, Alexander SR, Feneberg R, Schaefer F, Warady BA. Enterococcal peritonitis in children receiving chronic peritoneal dialysis. Nephrol Dial Transplant 2010; 25:4048-54. [PMID: 20501457 DOI: 10.1093/ndt/gfq295] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Peritonitis is a common complication of chronic peritoneal dialysis (CPD) and can be associated with technique failure. Enterococcus is an uncommon peritoneal pathogen in children receiving CPD but represents a potential therapeutic challenge due to its innate resistance to cephalosporins and emerging resistance to glycopeptides. METHODS The International Pediatric Peritonitis Registry is a global consortium of 47 paediatric dialysis centres designed to address validation of the International Society for Peritoneal Dialysis paediatric peritonitis treatment guidelines. Between 2001 and 2004, peritonitis episodes were assessed in 392 participating children receiving CPD. RESULTS Among the 392 patients, 340 episodes of culture-positive peritonitis were evaluated. Twenty of these episodes were due to Enterococcus species (5.9%). There were no clinical characteristics uniquely associated with enterococcal peritonitis at presentation. After 3 days of therapy, 75% of patients were pain free, 95% had decreased effluent cloudiness and 90% were afebrile. Only one patient required a catheter exchange, and all patients experienced full functional recovery. Despite broad in vitro resistance to cephalosporins and 21% resistance to glycopeptides, neither in vitro resistance pattern nor choice of empiric antibiotic regimen affected short- or long-term outcomes. CONCLUSIONS Enterococci are likely responsible for ∼6% of culture-positive peritonitis episodes in children receiving CPD. Although it was not possible to identify patients with enterococcal peritonitis based on presentation, clinical response was not associated with in vitro resistance patterns, and patients who initially received a cephalosporin-based empiric regimen until culture results are available are likely to respond quickly and have full functional recovery.
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Affiliation(s)
- Scott M Sutherland
- Stanford University Medical Center, Department of Pediatrics, Division of Nephrology, 300 Pasteur Drive, Room G-306, Stanford, CA 94035, USA.
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Lane JC, Warady BA, Feneberg R, Majkowski NL, Watson AR, Fischbach M, Kang HG, Bonzel KE, Simkova E, Stefanidis CJ, Klaus G, Alexander SR, Ekim M, Bilge I, Schaefer F. Relapsing peritonitis in children who undergo chronic peritoneal dialysis: a prospective study of the international pediatric peritonitis registry. Clin J Am Soc Nephrol 2010; 5:1041-6. [PMID: 20430942 DOI: 10.2215/cjn.05150709] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The International Pediatric Peritonitis Registry (IPPR) was established to collect prospective data regarding peritoneal dialysis (PD)-associated peritonitis in children. In this report, we present the IPPR results that pertain to relapsing peritonitis (RP). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was an online, prospective entry into the IPPR of data that pertain to peritonitis cases by participating centers. RESULTS Of 490 episodes of nonfungal peritonitis, 52 (11%) were followed by a relapse. There was no significant difference between RP and non-RP in distribution of causative organisms and antibiotic sensitivities. Initial empiric therapy-ceftazidime with either first-generation cephalosporin or glycopeptide (vancomycin or teicoplanin)-was not associated with relapse. Switching to monotherapy with a first-generation cephalosporin on the basis of culture results was associated with higher relapse rate (23%) than other final antibiotic therapies (0 to 9%). Culture-negative RP was less likely to have a satisfactory early treatment response than non-RP (82 versus 98%). Young age, single-cuff catheter, downward-pointing exit site, and chronic systemic antibiotic prophylaxis were additional independent risk factors for RP in the multivariate analysis. Compared with non-RP, RP was associated with a lower rate of full functional recovery (73 versus 91%), higher ultrafiltration problems (14 versus 2%), and higher rate of permanent PD discontinuation (17 versus 7%). CONCLUSIONS This is the largest multicenter, prospective study to date to examine RP in children. In addition, this is the first report in the literature to examine specifically the relationship of postempiric antibiotic treatment regimens to the subsequent risk for relapse.
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Affiliation(s)
- Jerome C Lane
- Division of Kidney Diseases, Department of Pediatrics, Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA.
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Chadha V, Schaefer FS, Warady BA. Dialysis-associated peritonitis in children. Pediatr Nephrol 2010; 25:425-40. [PMID: 19190935 PMCID: PMC2810362 DOI: 10.1007/s00467-008-1113-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2008] [Revised: 11/18/2008] [Accepted: 12/09/2008] [Indexed: 01/06/2023]
Abstract
Peritonitis remains a frequent complication of peritoneal dialysis in children and is the most common reason for technique failure. The microbiology is characterized by a predominance of Gram-positive organisms, with fungi responsible for less than 5% of episodes. Data collected by the International Pediatric Peritonitis Registry have revealed a worldwide variation in the bacterial etiology of peritonitis, as well as in the rate of culture-negative peritonitis. Risk factors for infection include young age, the absence of prophylactic antibiotics at catheter placement, spiking of dialysis bags, and the presence of a catheter exit-site or tunnel infection. Clinical symptoms at presentation are somewhat organism specific and can be objectively assessed with a Disease Severity Score. Whereas recommendations for empiric antibiotic therapy in children have been published by the International Society of Peritoneal Dialysis, epidemiologic data and antibiotic susceptibility data suggest that it may be desirable to take the patient- and center-specific history of microorganisms and their sensitivity patterns into account when prescribing initial therapy. The vast majority of patients are treated successfully and continue peritoneal dialysis, with the poorest outcome noted in patients with peritonitis secondary to Gram-negative organisms or fungi and in those with a relapsing infection.
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Affiliation(s)
- Vimal Chadha
- Department of Pediatrics, Section of Nephrology, Virginia Commonwealth University Medical Center, Richmond, VA USA
| | - Franz S. Schaefer
- Center for Pediatric and Adolescent Medicine, Section of Pediatric Nephrology, University of Heidelberg, Heidelberg, Germany
| | - Bradley A. Warady
- Department of Pediatrics, Section of Nephrology, The Children’s Mercy Hospital, Kansas City, MO USA
- University of Missouri–Kansas City School of Medicine, The Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108 USA
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Peritonitis in children on peritoneal dialysis in Cape Town, South Africa: epidemiology and risks. Pediatr Nephrol 2010; 25:2149-57. [PMID: 20645111 PMCID: PMC2923710 DOI: 10.1007/s00467-010-1592-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 05/08/2010] [Accepted: 05/25/2010] [Indexed: 11/27/2022]
Abstract
Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0-21.2). Median time to first infection was 2.03 months (range 0.1-21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socio-economic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socio-economic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success.
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Chand DH, Brier ME, Strife CF. Multicenter study of effects of pediatric peritoneal dialysis practices on bacterial peritonitis. Pediatr Nephrol 2010; 25:149-53. [PMID: 19705158 DOI: 10.1007/s00467-009-1295-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 07/23/2009] [Accepted: 07/24/2009] [Indexed: 11/28/2022]
Abstract
Bacterial peritonitis is a major cause of morbidity in pediatric peritoneal dialysis (PD) patients and can lead to catheter removal, hospitalizations, peritoneal membrane dysfunction, and sepsis. The goal of this prospective study was to determine whether the incidence of peritonitis had improved over time and what practice patterns influenced peritonitis. Two cohorts of PD patients within the End-stage Renal Disease (ESRD) Networks 9/10 and who were <21 years old were prospectively followed for 1 year in 1991 and 2002 and included 70 and 82 patients, respectively. A questionnaire was completed for each patient outlining demographic, clinical, and dialysis characteristics. A second questionnaire was completed for each peritonitis episode. The 2002 cohort was younger, included more nonwhites, and had fewer peritonitis episodes. A shift in practice patterns was evident, with more of the 2002 cohort receiving prophylactic antibiotics and omentectomy at catheter insertion and using cycler machines with a parent operator. Peritonitis-free interval was 10.8 months in 1991 and 17.3 months in 2002. The only variable statistically related to the lower rate of peritonitis in 2002 was fewer prior peritonitis events. The results show an improvement in peritonitis-free interval in studied patients on PD, which appears to be related to numerous changes in practice patterns.
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Affiliation(s)
- Deepa H Chand
- Nephrology and Hypertension, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA.
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Zurowska A, Feneberg R, Warady BA, Zimmering M, Monteverde M, Testa S, Calyskan S, Drozdz D, Salusky I, Kemper MJ, Ekim M, Verrina E, Misselwitz J, Schaefer F. Gram-negative peritonitis in children undergoing long-term peritoneal dialysis. Am J Kidney Dis 2008; 51:455-62. [PMID: 18295061 DOI: 10.1053/j.ajkd.2007.11.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 11/28/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND The proportion of gram-negative causative organisms in peritoneal dialysis-associated peritonitis is increasing. Little published information for this complication exists in children. The objective of this study is to evaluate the clinical presentation, early and late response to treatment, and identification of factors influencing the outcome of gram-negative peritonitis (GNP) in children. STUDY DESIGN Case series. SETTING AND PARTICIPANTS 104 children (aged 7.9 +/- 5.9 years) with 121 GNP episodes reported to the International Pediatric Peritonitis Registry from October 2001 through December 2004. PREDICTORS Patient, clinical, bacteriological, and treatment features. OUTCOMES Initial response to empirical treatment was assessed after approximately 72 hours of therapy. Final outcome was judged according to the occurrence of death, technique failure, relapse, need for catheter exchange, and a composite end point defining full functional recovery. RESULTS 44% of episodes of GNP occurred in children younger than 5 years. Causative organisms included Pseudomonas species, 21%; Klebsiella species, 18%; Escherichia coli, 17%; and Acinetobacter species, 12%. Thirty-two percent of organisms classified as gram-negative were not identified further. Clinical manifestations were severe and uniform for all causative gram-negative agents. A substantial proportion (20%) of organisms were resistant to ceftazidime, with resulting suboptimal response to empirical therapy. By day 3 of initial empiric treatment, 85% of children with GNP had improved clinically (39%, complete resolution; 46%, improvement in symptoms), 10% showed poor response, and 5% had worsening of symptoms. Multivariate analysis identified severe abdominal pain, use of a single-cuff catheter, and intermittent (versus continuous) intraperitoneal ceftazidime administration as independent predictors of worse initial response to treatment. Full functional recovery was achieved in 86% of episodes. Nineteen patients (16%) required catheter removal, 11 (9%) experienced a relapse, 7 (6%) discontinued peritoneal dialysis therapy permanently, and 3 died. Lack of clinical improvement after 72 hours of therapy (odds ratio, 5.39; P < 0.01) and the presence of an exit-site infection (odds ratio, 7.69; P = 0.01) independently increased the risk of an incomplete functional recovery. LIMITATIONS The study was not designed to assess absolute incidence figures or risk factors for the development of GNP in children. CONCLUSIONS GNP is a significant complication of long-term peritoneal dialysis therapy in children, and a substantial proportion of affected children are at risk of permanent sequelae. Because results of empiric treatment with ceftazidime are suboptimal in the setting of this infection, alternative antimicrobial agents should be reconsidered.
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Affiliation(s)
- Aleksandra Zurowska
- Department of Paediatric and Adolescent Nephrology and Hypertension, Medical University of Gdansk, Poland
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Teitelbaum I. The International Pediatric Peritonitis Registry: starting to walk. Kidney Int 2007; 72:1305-7. [PMID: 18004310 DOI: 10.1038/sj.ki.5002529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The International Pediatric Peritonitis Registry (IPPR) was created to assess and evaluate the validity of the pediatric peritonitis treatment guidelines issued by the International Society for Peritoneal Dialysis. The study by Schaefer et al., one of the first to emerge from the IPPR, describes regional variability in the frequency of culture-negative peritonitis and of Gram-negative infections. This analysis is a crucial step in the development of evidence-based treatment recommendations whereby to improve outcomes for the youngest peritoneal dialysis patients.
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Affiliation(s)
- I Teitelbaum
- Acute and Home Dialysis Programs, University of Colorado Hospital, Aurora, Colorado, USA.
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