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Obaid O, Torres-Ruiz T, Nazzal M, Wandtke Barber M, Rodriguez-Silva F, Dash S, Al-Jalodi O, Young A, Sferra J. Inpatient peritoneal dialysis catheters placed across the United States during a 3-year period: Lessons learned from 15,000 patients. Surgery 2024; 175:877-884. [PMID: 37953138 DOI: 10.1016/j.surg.2023.09.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/31/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Peritoneal dialysis is a popular option for patients with end-stage renal disease. A recent presidential executive order has incentivized in-home end-stage renal disease treatments, leading to an increase in peritoneal dialysis use. Guidelines exist for creating and maintaining peritoneal dialysis access without addressing the optimal technique. This study evaluates nationwide peritoneal dialysis catheter placement practices and their long-term outcomes. METHODS Retrospective cohort analysis of Nationwide Readmission Database from 2017 to 2019. Patients with end-stage renal disease undergoing inpatient peritoneal dialysis catheter placement were included. Six-month readmissions, mortality, and peritoneal dialysis catheter-specific outcome measures were assessed among survivors of admission, including catheter leakage, mechanical breakdown, displacement, revision or replacement, removal, exit site infections, intra-abdominal abscess, and sepsis. Binary logistic regression analyses were performed. RESULTS In the study, 14,863 patients with inpatient peritoneal dialysis catheter insertions were identified, of which 7,096 were analyzed (4,150 [59%] laparoscopic, 1,781 [25%] fluoroscopic, 1,165 [16%] open), 847 (12%) had major complications, 931 (13%) were readmitted, and 102 (1.4%) died within 6 months. Univariate analyses demonstrated that laparoscopy had higher mechanical complications, exit-site infections, catheter revision, and removal within 6 months, and fluoroscopy had higher sepsis and mortality. Multivariate analyses showed fluoroscopy was associated with intraabdominal abscess (adjusted odds ratio, 2.36; P = .025), laparoscopy with exit-site infections (adjusted odds ratio, 0.49; P = .005), and open surgery with catheter displacement (adjust odds ratio, 2.95; P = .021). CONCLUSION This is the first large-scale study on inpatient peritoneal dialysis catheter placement outcomes in the United States. Fluoroscopic and open surgical placements are routinely performed, but laparoscopy remains the mainstay with fewer exit-site infections. Overall, peritoneal dialysis is a safe option, with 1 in 9 patients having an infectious or mechanical complication within 6 months. Furthermore, large-scale prospective studies are warranted to identify the optimal placement technique.
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Affiliation(s)
- Omar Obaid
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Tania Torres-Ruiz
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH; Department of Surgery, Toledo Hospital, Promedica Health System, OH
| | - Munier Nazzal
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Meghan Wandtke Barber
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | | | - Siddhartha Dash
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Omar Al-Jalodi
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Alexander Young
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH
| | - Joseph Sferra
- Department of Surgery, University of Toledo College of Health and Life Sciences, Toledo, OH; Department of Surgery, Toledo Hospital, Promedica Health System, OH.
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Haggerty SP, Kumar SS, Collings AT, Alli VV, Miraflor E, Hanna NM, Athanasiadis DI, Morrell DJ, Ansari MT, Abou-Setta A, Walsh D, Stefanidis D, Slater BJ. SAGES peritoneal dialysis access guideline update 2023. Surg Endosc 2024; 38:1-23. [PMID: 37989887 DOI: 10.1007/s00464-023-10550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/17/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Minimally invasive surgery has been used for both de novo insertion and salvage of peritoneal dialysis (PD) catheters. Advanced laparoscopic, basic laparoscopic, open, and image-guided techniques have evolved as the most popular techniques. The aim of this guideline was to develop evidence-based guidelines that support surgeons, patients, and other physicians in decisions on minimally invasive peritoneal dialysis access and the salvage of malfunctioning catheters in both adults and children. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons reviewed the literature since the prior guideline was published in 2014 and developed seven key questions in adults and four in children. After a systematic review of the literature, by the panel, evidence-based recommendations were formulated using the Grading of Recommendations Assessment, Development and Evaluation approach. Recommendations for future research were also proposed. RESULTS After systematic review, data extraction, and evidence to decision meetings, the panel agreed on twelve recommendations for the peri-operative performance of laparoscopic peritoneal dialysis access surgery and management of catheter dysfunction. CONCLUSIONS In the adult population, conditional recommendations were made in favor of: staged hernia repair followed by PD catheter insertion over simultaneous and traditional start over urgent start of PD when medically possible. Furthermore, the panel suggested advanced laparoscopic insertion techniques rather than basic laparoscopic techniques or open insertion. Conditional recommendations were made for either advanced laparoscopic or image-guided percutaneous insertion and for either nonoperative or operative salvage. A recommendation could not be made regarding concomitant clean-contaminated surgery in adults. In the pediatric population, conditional recommendations were made for either traditional or urgent start of PD, concomitant clean or clean-contaminated surgery and PD catheter placement rather than staged, and advanced laparoscopic placement rather than basic or open insertion.
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Affiliation(s)
- Stephen P Haggerty
- Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL, 60201, USA.
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Amelia T Collings
- Department of Surgery, Hiram C. Polk, Jr., University of Louisville, Louisville, KY, USA
| | - Vamsi V Alli
- Department of Surgery, Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Emily Miraflor
- Department of Surgery, UCSF East Bay, University of California, San Francisco, CA, USA
| | - Nader M Hanna
- Department of Surgery, Queen's University, Kingston, ON, Canada
| | | | - David J Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Mohammed T Ansari
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Abou-Setta
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Danielle Walsh
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
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Duarsa GWK, Sugianto R, Tirtayasa PMW, Saniti NMA, Duarsa KHA. The prophylactic omentectomy procedure in reducing the complication rate of continuous ambulatory peritoneal dialysis in pediatric: A systematic review and meta-analysis. Arch Ital Urol Androl 2023; 95:12049. [PMID: 38059270 DOI: 10.4081/aiua.2023.12049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/11/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The role of the omentectomy procedure on Continuous Ambulatory Peritoneal Dialysis (CAPD) catheter placement in pediatric patients has been differently evaluated in the literature, with some studies showing improvement while others showing no difference. Our study aims to define the advantages of omentectomy compared to a procedure without omentectomy. METHODS The literature searching in online databases (PubMed/MEDLINE, Cochrane Library, EMBASE, Scopus, and ClinicalTrial.gov) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, has been registered on PROSPERO (CRD42023412846). The protocol was performed through April 2023 and focused on pediatric patients treated with an omentectomy procedure and related complications. The risk of bias in each study was assessed using the risk of bias for the non-randomized control trials (ROBINS-I). The effect estimates were extracted as risk ratios with 95% confidence intervals (CI). The heterogeneity of the studies was considered as high heterogeneity if I2 values above 50% or p < 0.05. RESULTS In the total of 676 articles identified in the database searching for screening, nine studies with 775 patients met the criteria for inclusion. The omentectomy procedure significantly showed a lower incidence of catheter obstruction compared to the control group, (OR 0.24 [95% CI, 0.12-0.49], p < 0.0001, I2 = 0%). Moreover, omentectomy demonstrated a similar trend in the rate of removal or reinsertion of the catheter with high heterogeneity, OR 0.25 [95% CI, 0.12-0.51), p = 0.0002, I2 = 70%). CONCLUSIONS The omentectomy procedure showed a lower incidence of catheter obstruction and complications leading to removal or reinsertion of the catheter.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali.
| | - Ronald Sugianto
- Medical Doctor Study Program, Faculty of Medicine, Universitas Udayana, Bali.
| | - Pande Made Wisnu Tirtayasa
- Department of Urology, Faculty of Medicine, Universitas Udayana, Universitas Udayana Teaching Hospital, Bali.
| | - Ni Made Apriliani Saniti
- Department of Surgery, Faculty of Medicine, Universitas Udayana, Prof. Dr. I.G.N.G Ngoerah General Hospital, Bali.
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Nada T, Kamei K, Sato M, Nishi K, Ogura M, Ito S. Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal dialysis: a single-center experience. Clin Exp Nephrol 2023; 27:791-799. [PMID: 37289336 DOI: 10.1007/s10157-023-02365-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/27/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce. METHODS We conducted a retrospective study on children aged < 20 years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30 days of catheter insertion. RESULTS Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14 days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7 days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7 days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis. CONCLUSIONS A break-in period of > 7 days and if possible 14 days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging.
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Affiliation(s)
- Taishi Nada
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Medical Center, 4-57 Urafune-Cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
- Department of Pediatrics, Yokohama City University Hospital, 3-9 Hukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan
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Hamada C. Relationship between laparoscopic and microscopic findings of peritoneum in peritoneal dialysis patients. J Artif Organs 2022:10.1007/s10047-022-01344-1. [PMID: 35920938 DOI: 10.1007/s10047-022-01344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 06/15/2022] [Indexed: 10/16/2022]
Abstract
Long-term exposure to the peritoneal dialysis solution (PDS) causes functional and morphological alterations that diminish the efficacy of peritoneal dialysis (PD). Macroscopic and microscopic findings, submesothelial compact zone (SMC) thickness and vascular patency, were associated with PD duration. The relationship between microscopic and laparoscopic morphological findings in PD patients was determined. A total of 78 laparoscopic intraperitoneal findings were recorded during PD catheter removal and 45 peritoneal tissues were obtained from the anterior parietal peritoneum. We examined macroscopic morphological findings in both parietal and visceral peritoneums and bowel movement and assessed the score semiquantitatively. SMC thickness and vascular patency were examined as microscopic findings. Total laparoscopic finding's score (LFS) and microscopic findings, SMC thickness and vascular patency, were associated with PD duration. Total LFS was related to SMC thickness in both visceral and parietal peritoneum, whereas it was related to vascular patency in parietal but not in visceral peritoneum. There was no relationship between microscopic findings and peritoneal surface color, properties, vasculopathy, and adhesion. Total LFS in patients with newly formed membrane and omentum atrophy was higher than in those without. There was a significant relationship between microscopic and laparoscopic findings in PD patients. It is important to evaluate laparoscopic findings in more PD patients to find the predictive findings of encapsulating peritoneal sclerosis development.
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Affiliation(s)
- Chieko Hamada
- Faculty of Health Science and Nursing, Juntendo University, Tokyo, Japan. .,Faculty of Health Science and Nursing, Juntendo University, 3-7-33 Omiya, Mishima, Shizuoka, 411-8787, Japan.
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Zhang Y, Yan G, Han F, Yang L, Shu J, Liu L, Zhang W, Shang A, Bai J. Application of indocyanine green and near-infrared fluorescence imaging for the assessment of peritoneal dialysis-related complications. Photodiagnosis Photodyn Ther 2022; 39:102881. [DOI: 10.1016/j.pdpdt.2022.102881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2022]
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Tangirala S, Devi U, Kumar T, Balakrishnan U, Amboiram P. Clinical Profile, Outcomes, and Complications in Neonates Undergoing Peritoneal Dialysis in a Tertiary Neonatal Care Unit - An Observational Study. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:337-342. [PMID: 37417188 DOI: 10.4103/1319-2442.379034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Peritoneal dialysis (PD) is the most common form of renal replacement therapy in neonates and there is a lot of heterogeneity in patient selection and outcomes across the various units. This study aimed to assess the indications, complications, and outcomes in terms of survival of PD. This is a retrospective study of 23 neonates who underwent acute PD at a tertiary care neonatal unit between August 2016 and July 2021. A cross-sectional poll was also conducted among the doctors who have been in the unit for the past 10 years regarding their experience in PD. The baseline, clinical, biochemical parameters, outcomes, and complications were analyzed. All statistical analyses were performed using the IBM SPSS Statistics version 23.0 software. The mean (±standard deviation) gestational age and birth weights of neonates were 32.6 ± 4 weeks and 1743 ± 922 g, respectively. Six (26%) babies had extremely low birth weight, five (22%) very low birth weight (VLBW), and seven (30%) low birth weight. The indications were acute kidney injury [17/23 (74%)], fluid overload [3/23 (17%)], suspected inborn errors of metabolism [2/23 (9%)] and hypernatremia [1/23 (4%)]. A pigtail catheter (74%) was used in most of them. Catheter block was noticed in four babies and peritonitis in two neonates. We did not encounter any complications during the procedure, and PD appears to be practicable across all gestational ages and birth weights.
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Affiliation(s)
- Susmitha Tangirala
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Usha Devi
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Thinesh Kumar
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Umamaheswari Balakrishnan
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Prakash Amboiram
- Department of Neonatology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Omental Procedures During Peritoneal Dialysis Insertion: A Systematic Review and Meta-Analysis. World J Surg 2022; 46:1183-1195. [PMID: 35076821 DOI: 10.1007/s00268-021-06413-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Peritoneal dialysis (PD) is an option for ultrafiltration for patients with end-stage renal disease. Once placed, PD catheters may malfunction often due to omental wrapping. Omental procedures such as omentectomy and omentopexy may reduce this risk. This investigation aims to perform a systematic review and meta-analysis of the literature on the role of omental procedures on PD catheter insertions. METHODS Following protocol registration on PROSPERO (CRD42020218950), a systematic review was performed in accordance with the Cochrane Collaboration. A literature search was performed in February 2021 across Medline, EMBASE, Scopus, and Cochrane Library. Records with patients who underwent PD catheter insertion with and without omental manipulation were included. The records underwent screening, full-text review, and data extraction. Study qualities were assessed using RoBINS-I and RoB2. Effect estimates were extracted as risk ratios and corresponding 95% confidence intervals (CI) were pooled using inverse variance method with random-effect model. RESULTS Of 510 records identified, 15 studies were included in the meta-analysis (1 RCT, 2 prospective, 12 retrospective). With omental procedures, there was decreased the likelihood of failure requiring removal of PD catheter (RR 0.47, 95% CI 0.38, 0.58) and PD catheter obstruction (RR 0.23, 95% CI 0.14, 0.39); there was no difference in likelihood of catheter malposition or migration (RR 0.87, 95% CI 0.23, 3.29) or peritonitis (RR 0.74, 95% CI 0.40, 1.35). CONCLUSION Based on the current low to moderate quality of evidence, omental manipulation at the time of PD catheter insertion confers benefits of decreased obstruction and failure requiring removal.
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Xing Y, Sheng K, Liu H, Wu S, Wei H, Li R, Wang J, Li Z, Tong X. Acute peritoneal dialysis is an efficient and reliable alternative therapy in preterm neonates with acute kidney injury. Transl Pediatr 2021; 10:893-899. [PMID: 34012838 PMCID: PMC8107877 DOI: 10.21037/tp-20-469] [Citation(s) in RCA: 3] [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] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to assess the underlying causes and outcomes of acute peritoneal dialysis (APD) and the complications of PD procedure in preterm neonates with acute kidney injury (AKI). METHODS A retrospective study of 21 preterm neonates who underwent APD in a neonatal intensive care unit (NICU) in Peking University Third Hospital between 2016 and 2019 was conducted. The demographic, clinical, biochemistry, and PD procedure--related information of the neonates was analyzed. RESULTS Of the 21 preterm neonates, the average gestational age (GA) was 28.9±2.6 weeks, and the average birth weight was 1,226.7±495.3 g, and included 5 (23.8%) low-birth-weight infants (LBWIs), 7 (33.3%) very LBWIs (VLBWIs), and 9 (42.9%) extremely LBWIs (ELBWIs). The major underlying causes for APD were asphyxia (66.7%, n=14) and twin-twin transfusion syndrome (47.6%, n=10). PD procedure-related complications mainly involved inadequate drainage (n=5, 23.8%) and drainage infections (n=2, 9.5%). The median duration of PD was 3 days (range, 1 hour-20 days). Compared to pre-PD, blood urea nitrogen (BUN) and serum K+ levels were significantly decreased post-PD (P<0.05). After PD, edema disappeared in 77.8% (n=14/18) of patients, and 42.9% patients (n=9/21) gained normal urine output. Although 8 of the 21 (38.1%) patients died and 6 (29.6%) abandoned therapy, 7 (33.3%) patients including 1 VLBWI and 3 ELBWI survived. CONCLUSIONS APD is an efficient and reliable alternative route of renal replacement therapy particularly for reducing BUN and K+ levels in preterm neonates with AKI. APD is practicable in critically ill preterm neonates, even in LBWIs and ELBWIs.
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Affiliation(s)
- Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Kai Sheng
- Department of emergency, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hui Liu
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Song Wu
- Department of Cardiac Surgery, Peking University Third Hospital, Beijing, China
| | - Hongling Wei
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rui Li
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Jing Wang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Zailing Li
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Xiaomei Tong
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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Nourse P, Cullis B, Finkelstein F, Numanoglu A, Warady B, Antwi S, McCulloch M. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics). Perit Dial Int 2021; 41:139-157. [PMID: 33523772 DOI: 10.1177/0896860820982120] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
SUMMARY OF RECOMMENDATIONS 1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C)2. Access and fluid delivery for acute PD in children.2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal)2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal)2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal)2.4 Rigid catheters placed using a stylet should only be used when soft Seldinger catheters are not available, with the duration of use limited to <3 days to minimize the risk of complications. (1C) (minimum standard)2.5 Improvised PD catheters should only be used when no standard PD access is available. (practice point) (minimum standard)2.6 We recommend the use of prophylactic antibiotics prior to PD catheter insertion. (1B) (optimal)2.7 A closed delivery system with a Y connection should be used. (1A) (optimal) A system utilizing buretrols to measure fill and drainage volumes should be used when performing manual PD in small children. (practice point) (optimal)2.8 In resource limited settings, an open system with spiking of bags may be used; however, this should be designed to limit the number of potential sites for contamination and ensure precise measurement of fill and drainage volumes. (practice point) (minimum standard)2.9 Automated peritoneal dialysis is suitable for the management of paediatric AKI, except in neonates for whom fill volumes are too small for currently available machines. (1D)3. Peritoneal dialysis solutions for acute PD in children3.1 The composition of the acute peritoneal dialysis solution should include dextrose in a concentration designed to achieve the target ultrafiltration. (practice point)3.2 Once potassium levels in the serum fall below 4 mmol/l, potassium should be added to dialysate using sterile technique. (practice point) (optimal) If no facilities exist to measure the serum potassium, consideration should be given for the empiric addition of potassium to the dialysis solution after 12 h of continuous PD to achieve a dialysate concentration of 3-4 mmol/l. (practice point) (minimum standard)3.3 Serum concentrations of electrolytes should be measured 12 hourly for the first 24 h and daily once stable. (practice point) (optimal) In resource poor settings, sodium and potassium should be measured daily, if practical. (practice point) (minimum standard)3.4 In the setting of hepatic dysfunction, hemodynamic instability and persistent/worsening metabolic acidosis, it is preferable to use bicarbonate containing solutions. (1D) (optimal) Where these solutions are not available, the use of lactate containing solutions is an alternative. (2D) (minimum standard)3.5 Commercially prepared dialysis solutions should be used. (1C) (optimal) However, where resources do not permit this, locally prepared fluids may be used with careful observation of sterile preparation procedures and patient outcomes (e.g. rate of peritonitis). (1C) (minimum standard)4. Prescription of acute PD in paediatric patients4.1 The initial fill volume should be limited to 10-20 ml/kg to minimize the risk of dialysate leakage; a gradual increase in the volume to approximately 30-40 ml/kg (800-1100 ml/m2) may occur as tolerated by the patient. (practice point)4.2 The initial exchange duration, including inflow, dwell and drain times, should generally be every 60-90 min; gradual prolongation of the dwell time can occur as fluid and solute removal targets are achieved. In neonates and small infants, the cycle duration may need to be reduced to achieve adequate ultrafiltration. (practice point)4.3 Close monitoring of total fluid intake and output is mandatory with a goal to achieve and maintain normotension and euvolemia. (1B)4.4 Acute PD should be continuous throughout the full 24-h period for the initial 1-3 days of therapy. (1C)4.5 Close monitoring of drug dosages and levels, where available, should be conducted when providing acute PD. (practice point)5. Continuous flow peritoneal dialysis (CFPD)5.1 Continuous flow peritoneal dialysis can be considered as a PD treatment option when an increase in solute clearance and ultrafiltration is desired but cannot be achieved with standard acute PD. Therapy with this technique should be considered experimental since experience with the therapy is limited. (practice point) 5.2 Continuous flow peritoneal dialysis can be considered for dialysis therapy in children with AKI when the use of only very small fill volumes is preferred (e.g. children with high ventilator pressures). (practice point).
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Affiliation(s)
- Peter Nourse
- Pediatric Nephrology Red Cross War Memorial Children's Hospital, 37716University of Cape Town, South Africa
| | - Brett Cullis
- Hilton Life Hospital, Renal and Intensive Care Units, Hilton, South Africa
| | | | - Alp Numanoglu
- Department of Surgery 63731Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Bradley Warady
- Division of Nephrology, University of Missouri-Kansas City School of Medicine, MO, USA
| | - Sampson Antwi
- Department of Child Health, Kwame Nkrumah University of Science & Technology/Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mignon McCulloch
- Pediatric Nephrology Red Cross War Memorial Children's Hospital, 37716University of Cape Town, South Africa
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Aksoy GK, Ekim M, Bakkaloğlu SA, Coşkun S, Delibaş A, Conkar S, Yılmaz D, Kara A, Saygılı SK, Büyükkaragöz B, Yıldırım ZY, Çomak E, Gürgöze MK, Sever L, Noyan A, Bayazıt AK, Düşünsel R. Evaluation of non-infectious complications of peritoneal dialysis in children: a multicenter study. Pediatr Nephrol 2021; 36:417-423. [PMID: 32728843 DOI: 10.1007/s00467-020-04719-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the most common kidney replacement therapy in children. Complications associated with PD affect treatment success and sustainability. The aim of this study was to investigate the frequency of PD-related non-infectious complications and the predisposing factors. METHODS Retrospective data from 11 centers in Turkey between 1998 and 2018 was collected. Non-infectious complications of peritoneal dialysis (NICPD), except metabolic ones, in pediatric patients with regular follow-up of at least 3 months were evaluated. RESULTS A total of 275 patients were included. The median age at onset of PD and median duration of PD were 9.1 (IQR, 2.5-13.2) and 7.6 (IQR, 2.8-11.9) years, respectively. A total of 159 (57.8%) patients encountered 302 NICPD within the observation period of 862 patient-years. The most common NIPCD was catheter dysfunction (n = 71, 23.5%). At least one catheter revision was performed in 77 patients (28.0%). Longer PD duration and presence of swan neck tunnel were associated with the development of NICPD (OR 1.191; 95% CI 1.079-1.315, p = 0.001 and OR 1.580; 95% CI 0.660-0.883, p = 0.048, respectively). Peritoneal dialysis was discontinued in 145 patients; 46 of whom (16.7%) switched to hemodialysis. The frequency of patients who were transferred to hemodialysis due to NICPD was 15.2%. CONCLUSIONS Peritoneal dialysis-related non-infectious complications may lead to discontinuation of therapy. Presence of swan neck tunnel and long duration of PD increased the rate of NICPD. Careful monitoring of patients is necessary to ensure that PD treatment can be maintained safely.
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Affiliation(s)
- Gulsah Kaya Aksoy
- Department of Pediatric Nephrology, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Mesiha Ekim
- Faculty of Medicine, Department of Pediatric Nephrology, Ankara University, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Seda Coşkun
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
| | - Ali Delibaş
- Faculty of Medicine, Department of Pediatric Nephrology, Mersin University, Mersin, Turkey
| | - Seçil Conkar
- Faculty of Medicine, Department of Pediatric Nephrology, Ege University, Izmir, Turkey
| | - Dilek Yılmaz
- Faculty of Medicine, Department of Pediatric Nephrology, Adnan Menderes University, Aydin, Turkey
| | - Aslıhan Kara
- Faculty of Medicine, Department of Pediatric Nephrology, Fırat University, Elazig, Turkey
| | - Seha K Saygılı
- Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, Cerrahpaşa, Istanbul, Turkey
| | - Bahar Büyükkaragöz
- Faculty of Medicine, Department of Pediatric Nephrology, Gazi University, Ankara, Turkey
| | - Zeynep Y Yıldırım
- Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, Istanbul, Turkey
| | - Elif Çomak
- Faculty of Medicine, Department of Pediatric Nephrology, Akdeniz University, Antalya, Turkey
| | - Metin K Gürgöze
- Faculty of Medicine, Department of Pediatric Nephrology, Fırat University, Elazig, Turkey
| | - Lale Sever
- Faculty of Medicine, Department of Pediatric Nephrology, Istanbul University, Istanbul, Turkey
| | - Aytül Noyan
- Faculty of Medicine, Department of Pediatric Nephrology, Baskent University, Adana, Turkey
| | - Aysun K Bayazıt
- Faculty of Medicine, Department of Pediatric Nephrology, Çukurova University, Adana, Turkey
| | - Ruhan Düşünsel
- Faculty of Medicine, Department of Pediatric Nephrology, Erciyes University, Kayseri, Turkey
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12
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Surgical versus percutaneous catheter placement for peritoneal dialysis: an updated systematic review and meta-analysis. J Nephrol 2020; 34:1681-1696. [PMID: 33197001 DOI: 10.1007/s40620-020-00896-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/28/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND No consensus currently exists regarding the optimal approach for peritoneal dialysis catheter placement. We aimed to compare the outcomes of percutaneous and surgical peritoneal dialysis catheter placement. METHODS A systematic review of the literature was performed using the MEDLINE, Cochrane Library, and Scopus databases (end-of-search date: August 29th, 2020). We included studies comparing percutaneous (blind, under fluoroscopic/ultrasound guidance, and "half-perc") and surgical peritoneal dialysis catheter placement (open and laparoscopic) in terms of their infectious complications (peritonitis, tunnel/exit-site infections), mechanical complications (leakage, inflow/outflow obstruction, migration, hemorrhage, hernia, bowel perforation) and long-term outcomes (malfunction, removal, replacement, surgery required, and mortality). RESULTS Thirty-four studies were identified, including thirty-two observational studies (twenty-six retrospective and six prospective) and two randomized controlled trials. Percutaneous placement was associated with significantly lower rates of tunnel/exit-site infection [relative risk (RR) 0.72, 95% confidence interval (CI) 0.56-0.91], catheter migration (RR 0.68, 95% CI 0.49, 0.95), and catheter removal (RR 0.73, 95% CI 0.60-0.88). The 2-week and 4-week rates of early tunnel/exit-site infection were also lower in the percutaneous group (RR 0.45, 95% CI 0.22-0.93 and RR 0.41, 95% CI 0.27-0.63, respectively). No statistically significant difference was observed regarding other outcomes, including catheter survival and mechanical complications. CONCLUSION Overall, the quality of published literature on the field of peritoneal dialysis catheter placement is poor, with a small percentage of studies being randomized clinical trials. Percutaneous peritoneal dialysis catheter placement is a safe procedure and may result in fewer complications, such as tunnel/exit-site infections, and catheter migration, compared to surgical placement. PROTOCOL REGISTRATION PROSPERO CRD42020154951.
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13
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Lima M, Di Salvo N, Marchi G, Catania VD, Libri M, Gargano T. Peritoneal dialysis catheters in pediatric patients: 10 years of experience in a single centre. LA PEDIATRIA MEDICA E CHIRURGICA 2020; 42. [PMID: 33103403 DOI: 10.4081/pmc.2020.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
Peritoneal Dialysis (PD) is one of the numerous options for chronic dialysis and in many cases when access for acute dialysis is required early in a hospital course, at any age. PD catheter can be inserted with an open or laparoscopic approach. The complication rate after catheter insertion is still high, as reported in published literature. We present the experience matured at our Centre in the last 10 years on implantation of peritoneal dialysis catheters in children, emphasising surgical complications. We conducted a retrospective study on patients who underwent PD at our Centre in a range period of 10 years. We analysed patients 'demographic data, past and present medical, perioperative and post-operative data, permanence of the catheter, duration of dialysis, the gap between placement and use, outcomes and complications. We compared the data, dividing patients in 2 groups: patients operated with a traditional open technique and patients operated laparoscopically. We retrospectively reviewed 29 children with an average age of 3years and 6 months. Mean age was 42 months (1 month; 8 years) for the VLS group, 18 months (11 days, 4 years) for the OT group. Mean operative time was 106 min for the VLS group; 44 min for the OT group. The Catheter permanence period was 17 days (12h-64 days). Duration of dialysis was between 48 hours and 23 days (average 8 days). In the total population, we registered 8 complications (5 minor, 3 major), the overall complication rate being 33 % (minor complication rate 21%, major complication rate 12,5 %). 6 complications occurred in patients operated laparoscopically (6/14 = 36 %); 2 complications in the OT group (2/10 = 20 %). The complication rate after PD catheter insertion is still high. Advantages and disadvantages of the open and laparoscopic approach must be known. Both minor and major complications, such as bowel perforations and occlusions, must be understood and differentiated.
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Affiliation(s)
- Mario Lima
- Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.
| | - Niel Di Salvo
- Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.
| | - Giovanni Marchi
- Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.
| | | | - Michele Libri
- Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.
| | - Tommaso Gargano
- Department of Pediatric Surgery, Sant'Orsola University-Hospital, University of Bologna.
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14
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Wong YS, Pang KKY, Ma ALT, Tong PC, Tam YH. A standardized technique of laparoscopic placement of peritoneal dialysis catheter with omentectomy and closure of patent processus vaginalis: A 3-in-1 minimally invasive surgical approach in children. J Pediatr Surg 2020; 55:1914-1919. [PMID: 31662192 DOI: 10.1016/j.jpedsurg.2019.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/12/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Omental wrapping is a common cause for catheter failure in children on peritoneal dialysis (PD). Previous studies are conflicting in the benefits of omentectomy. METHODS We conducted a retrospective study comparing children who underwent PD catheter placement by a standardized laparoscopic three-in-one technique (lap3-in-1) from 2013 to 2018 versus a historical control cohort by open surgery without omentectomy. Lap3-in-1technique combined catheter placement with well-defined indication and extent of omentectomy, and closure of any patent processus vaginalis (PPV). RESULTS There were 33 and 32 children in the lap3-in-1 and control cohorts respectively. 4/33(12.1%) in lap3-in-1 had reoperations for catheter failures which equated 1 reoperation per 144 catheter months. No reoperations were performed in lap3-in-1 cohort for omental wrapping or inguinal hernia, compared with 13/32 (41%; p < 0.001) and 5/32 (16%; p = 0.02) in the control cohort. Kaplan Meier survival curves showed significantly longer catheter life in the lap3-in-1 cohort (p < 0.001). In multivariate analysis by the COX proportional hazards model, the lap3-in-1 approach had significantly reduced risk of reoperation for catheter failure (HR 0.11; 95% CI: 0.04-0.31; p < 0.001). CONCLUSIONS The lap3-in-1 technique is effective in selecting those children who would benefit from omentectomy, and avoiding a second operation for inguinal hernia which develops after PD. LEVEL OF EVIDENCE Treatment study, level III.
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Affiliation(s)
- Yuenshan Sammi Wong
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Kristine Kit Yi Pang
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Alison Lap Tak Ma
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Pak Chiu Tong
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, China
| | - Yuk Him Tam
- Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China..
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Klinkner DB, Siddiqui S. Renal dysfunction in the pediatric surgical patient: When to intervene. Semin Pediatr Surg 2019; 28:57-60. [PMID: 30824136 DOI: 10.1053/j.sempedsurg.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal dysfunction is very common in the pediatric surgical critical care patient, with an estimated incidence of up to 35% in the PICU population. It impacts multiple other organ systems, particularly ventilation, and adds to the morbidity and mortality in children with multisystem organ dysfunction. In this article, we review the definitions and stages of renal failure in the pediatric population, identify which of these are more likely to require renal replacement therapy, and identify the indications for the different types of intervention. In addition, the complications of each form of therapy, along with management options, will be discussed. Finally, we will discuss the immediate and long-term outcomes for pediatric patients from neonates to adolescents.
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Affiliation(s)
- Denise B Klinkner
- Division of Pediatric Surgery, Mayo Clinic, Rochester, MN, United States.
| | - Sabina Siddiqui
- Division of Pediatric Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, United States.
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