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Park PG, Ahn YH, Kang HG, Ha IS. Decreased incidence of peritoneal dialysis-associated peritonitis in young children. J Paediatr Child Health 2024. [PMID: 39091153 DOI: 10.1111/jpc.16630] [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: 12/11/2023] [Revised: 07/05/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
AIM Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades. METHODS This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups. RESULTS A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period. CONCLUSIONS The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.
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Affiliation(s)
- Peong Gang Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yo Han Ahn
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hee Gyung Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
- Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Il-Soo Ha
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
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Akiyama M, Kamei K, Nishi K, Kaneda T, Inoki Y, Osaka K, Sato M, Ogura M, Ito S. Frequency and prognosis of peritoneal dialysis-associated peritonitis in children. Clin Exp Nephrol 2024; 28:692-700. [PMID: 38472543 DOI: 10.1007/s10157-024-02482-x] [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: 05/08/2023] [Accepted: 02/26/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Peritonitis is the leading cause of peritoneal dialysis (PD) discontinuation. However, few data concern risk factors of peritonitis development and catheter removal caused by treatment failure in pediatric patients. METHODS This single-center, retrospective study analyzed data from pediatric patients who underwent chronic PD between March 2002 and June 2022. The incidence rates of peritonitis by the person-year method were calculated, and they were stratified by patient age groups. Risk factors for peritonitis development and catheter removal were also analyzed by multivariate analysis using logistic regression model. RESULTS Ninety patients were enrolled, and 62 peritonitis episodes were observed in 41 (46%) patients. The incidence rate of peritonitis was 0.21 episodes per patient-year, which was the highest in children aged under 2 years old (0.26 episodes per patient-year). Moreover, 44 (71%) cases were successfully cured by antibiotics alone, although 17 (27%) cases required catheter removal, and 4 (6%) cases transitioned to chronic hemodialysis because of peritoneal dysfunction. One patient died. The risk factor for peritonitis development and catheter removal caused by treatment failure was PD insertion at under 2 years old (odds ratio = 2.5; P = 0.04) and Pseudomonas aeruginosa (odds ratio = 11.0; P = 0.04) in the multivariate analysis. P. aeruginosa was also a risk factor for difficulty in re-initiating PD (P = 0.004). CONCLUSIONS The incidence rate of peritonitis was the highest in children under 2 years old. P. aeruginosa peritonitis is a risk factor for catheter removal and peritoneal dysfunction.
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Affiliation(s)
- Misaki Akiyama
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
| | - Kentaro Nishi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoya Kaneda
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuta Inoki
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Kei Osaka
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Mai Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Masao Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Shuichi Ito
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Yokohama City University, Kanagawa, Japan
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3
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Fati F, Pulvirenti R, Longo G, Antoniello LM, Zambaiti E, Gamba P. Percutaneous endoscopic gastrostomy in children receiving peritoneal dialysis: A tertiary centre long-term experience and literature review. Perit Dial Int 2024:8968608231223812. [PMID: 38265012 DOI: 10.1177/08968608231223812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Children with severe chronic kidney disease receiving maintenance peritoneal dialysis (PD) are often malnourished and may require nutritional supplementation. Recent PD guidelines address laparoscopic and open surgical gastrostomy as safe approaches in children established on PD, while existing evidence on percutaneous endoscopic gastrostomy (PEG) is still lacking; as well as the role of perioperative antibiotic and antifungal prophylaxis. Hence, this study aimed to report our experience with PEG placement in patients on PD and compare it with the available literature. METHODS We retrospectively reviewed the medical records from patients on PD, who underwent PEG placement at a tertiary referral centre between 2000 and 2020. Data on perioperative management, complications and outcomes were retrieved. An extensive literature search was performed; studies describing PEG placement and perioperative prophylaxis in patients on PD were used as a comparison. Descriptive statistical analysis was conducted. RESULTS Seven patients (five males) were included. Perioperative antibiotic and antifungal prophylaxis were standard practice. At a median follow-up of 27 months (10-75), the peritonitis rate was 0.2 patient/years. No statistical significance was found between the peritonitis rate before and after PEG placement (p = 0.2). Patients' demographics and postoperative complications were comparable to the reported studies. CONCLUSIONS Based on our experience, our technique of PEG insertion with antimicrobial prophylaxis is feasible and associated with an acceptable complication risk in patients on PD. Further multicentric studies about surgical technique in patients on PD will be necessary to verify the feasibility of PEG and standardise the perioperative protocol.
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Affiliation(s)
- Federica Fati
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Rebecca Pulvirenti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Germana Longo
- Pediatric Nephrology, Dialysis and Transplant Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Luca Maria Antoniello
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
| | - Elisa Zambaiti
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
- Pediatric Surgery Unit, Patologia e Cura del Bambino Department, Ospedale Infantile Regina Margherita, Turin, Italy
| | - Piergiorgio Gamba
- Pediatric Surgery Unit, Women's and Children's Health Department, University Hospital of Padua, Italy
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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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Kamath N, Borzych-Dużałka D, Kaur A, Neto G, Arbeiter K, Yap YC, Lahoche A, Eid L, Hooman N, Richardson T, Schaefer F, Warady BA. Pediatric peritoneal dialysis training program and its relationship to peritonitis: a study of the International Pediatric Peritoneal Dialysis Network. Pediatr Nephrol 2023; 38:4111-4118. [PMID: 37405492 DOI: 10.1007/s00467-023-05995-x] [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: 01/11/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND The guidelines for training of patients and caregivers to perform home peritoneal dialysis (PD) uniformly include recommendations pertaining to the prevention of peritonitis. The objective of this study conducted by the International Pediatric Peritoneal Dialysis Network (IPPN) was to investigate the training practices for pediatric PD and to evaluate the impact of these practices on the peritonitis and exit-site infection (ESI) rate. METHODS A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors. RESULTS Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24 hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (< 20 hours) training duration and lower number of training tools (both p < 0.02) were associated with higher peritonitis rate, after adjustment for proportion of treated infants and income of country of residence. CONCLUSIONS An association between training duration and the number of training tools represent potentially modifiable risk factors to reduce peritonitis rates within the pediatric PD population. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
| | - Dagmara Borzych-Dużałka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdańsk, Gdańsk, Poland
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Amrit Kaur
- Royal Manchester Children's Hospital, Manchester, UK
| | - Gisela Neto
- Pediatric Nephrology Unit, Dona Estefania Hospital, Lisbon, Portugal
| | | | - Yok Chin Yap
- Women and Children Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | | | - Loai Eid
- Dubai Hospital, Dubai, United Arab Emirates
| | - Nakysa Hooman
- Ali Asghar Clinical Research Development Center, Department of Pediatrics, Iran University of Medical Science, Tehran, Iran
| | | | - Franz Schaefer
- Division of Pediatric Nephrology, Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, USA
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Claes DJ, Richardson T, Harer MW, Keswani M, Neu A, Mahon ACR, Somers MJ, Traum AZ, Warady BA. Survival of neonates born with kidney failure during the initial hospitalization. Pediatr Nephrol 2023; 38:583-591. [PMID: 35655038 DOI: 10.1007/s00467-022-05626-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Survival to hospital discharge in neonates born with kidney failure has not been previously described. METHODS This was a retrospective, observational analysis of the Pediatric Health Information System (PHIS) database from 2005 to 2019. Primary outcome was survival at discharge; secondary outcomes were hospital and ICU length of stay (LOS). Univariate analysis was performed to describe the population by birth weight (BW) and characterize survival; multivariable generalized liner mixed modeling assuming a binomial distribution and logit link was performed to identify mortality risk factors. RESULTS Of 213 neonates born with kidney failure (median BW 2714 g; GA 35 weeks; 68% male), 4 (1.9%) did not receive dialysis or peritoneal dialysis (PD) catheter placement, 152 (72.9%) received PD only, 49 (23.4%) received PD plus extracorporeal dialysis (ECD), and 8 (3.4%) were treated with an undocumented dialysis modality. Median age at dialysis initiation was 7 days; median hospital LOS and ICU LOS were 84 and 69 days, respectively. One-hundred and sixty-two patients (76%) survived to discharge. Non-survivors (n = 51) were more likely to have received ECD and mechanical ventilation, and had a longer duration of mechanical ventilation. Every day of mechanical ventilation increased the mortality odds by 2% (n = 189; adjusted OR 1.02; 1.01, 1.03); in addition, the odds of mortality were 2 times higher in those who received ECD vs. only PD (adjusted OR 2.25; 1.04, 4.86). CONCLUSIONS Survival to initial hospital discharge occurs in the majority of neonates born with kidney failure. Predictors of increased mortality included longer duration of mechanical ventilation, as well as the requirement for ECD. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Donna J Claes
- Division of Pediatric Nephrology, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA.
| | | | - Matthew W Harer
- Division of Neonatology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Mahima Keswani
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alicia Neu
- Division of Pediatric Nephrology, The John's Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison C Redpath Mahon
- Division of Pediatric Nephrology, Department of Pediatrics, University of Wisconsin, Madison, WI, USA
| | - Michael J Somers
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Avram Z Traum
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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Hirano D, Inoue E, Sako M, Ashida A, Honda M, Takahashi S, Iijima K, Hattori M. Survival analysis among pediatric patients receiving kidney replacement therapy: a Japanese nationwide cohort study. Pediatr Nephrol 2023; 38:1-7. [PMID: 35488903 DOI: 10.1007/s00467-022-05568-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limited data are available on the survival and causes of death in pediatric patients with chronic kidney disease (CKD) stage 5 receiving kidney replacement therapy (KRT) in Asia. METHODS Data were obtained from the Japanese nationwide cross-sectional CKD stage 5 survey on pediatric patients (<20 years of age) who started KRT from 2006 to 2013. The cohort was divided into three groups according to age at the start of KRT: <1, 1-5, and 6-19 years. RESULTS Among the 701 children who were included, 59.3% were boys. Peritoneal dialysis was the most common initial modality of KRT (60.3%). Median age at KRT initiation was 10.2 years. Infants (<1 year old) accounted for 16.0% of the total cohort. Overall survival at 1 and 5 years was 97.2% and 92.5%, respectively. Infants had significantly lower survival rates than the other groups (hazard ratio, 5.35; 95% CI, 2.60-11.03; P < 0.001). In contrast, after the age of 1 year, the survival rate improved and did not differ from that of other age groups. The most common causes of death were infection (35.9%) and sudden death (15.4%). CONCLUSIONS The overall survival rate of pediatric patients with CKD stage 5 in Japan is like that in other high-income countries. Age at initiation of KRT is an important factor affecting survival since the poorest survival rate was observed in infants. Further improvement in infant dialysis therapy is still needed to improve survival of the youngest children. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Daishi Hirano
- Department of Pediatrics, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-0003, Japan.
| | - Eisuke Inoue
- Showa University Research Administration Center, Showa University, Tokyo, Japan
| | - Mayumi Sako
- Department of Clinical Research Promotion, Clinical Research Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Masataka Honda
- Department of Nephrology, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | | | - Kazumoto Iijima
- Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.,Department of Advanced Pediatric Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
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Slagle C, Schuh M, Grisotti G, Riddle S, Reddy P, Claes D, Lim FY, VanderBrink B. In utero renal failure. Semin Pediatr Surg 2022; 31:151195. [PMID: 35725056 DOI: 10.1016/j.sempedsurg.2022.151195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cara Slagle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States.
| | - Meredith Schuh
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Gabriella Grisotti
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Stefanie Riddle
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7009, United States
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Donna Claes
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, United States
| | - Foong-Yen Lim
- Division of Pediatric General and Thoracic Surgery and Center for Fetal Care, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati College of Medicine, United States
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Kempf C, Holle J, Berns S, Henning S, Bufler P, Müller D. Feasibility of percutaneous endoscopic gastrostomy insertion in children receiving peritoneal dialysis. Perit Dial Int 2021; 42:482-488. [PMID: 34784824 DOI: 10.1177/08968608211057651] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred dialysis modality for paediatric patients with end-stage kidney disease. Frequently, malnutrition is encountered. Percutaneous endoscopic gastrostomy (PEG) is the preferred mode of feeding because of its minimal invasive mode of placement and easy handling in daily life. However, reports of a high risk for early post-interventional peritonitis hampered this procedure during PD and controlled studies on the benefit of peri-interventional management to prevent peritonitis are lacking. Here, we report the safety profile of PEG insertion among a cohort of children on PD by using a prophylactic antibiotic and antifungal regimen as well as modification of the PD programme. METHODS We performed a single-centre analysis of paediatric PD patients receiving PEG placement between 2015 and 2020. Demographic data, peri-interventional prophylactic antibiotic and antifungal treatment as well as modification of the PD programme were gathered and the incidence of peritonitis within a period of 28 days after PEG was calculated. RESULTS Eight PD patients (median weight 6.7 kg) received PEG insertion. Antibiotic and antifungal prophylaxis were prescribed for median time of 4.0 and 5.0 days, respectively. After individual reduction of PD intensity, all patients continued their regular PD programme after a median of 6 days. One patient developed peritonitis within 24 h after PEG insertion and simultaneous surgery for hydrocele. CONCLUSIONS Applying an antibiotic and antifungal prophylactic regime as well as an adapted PD programme may reduce the risk for peritonitis in paediatric PD patients who receive PEG procedure.
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Affiliation(s)
- Caroline Kempf
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
| | - Johannes Holle
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
| | - Susanne Berns
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
| | - Stephan Henning
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
| | - Philip Bufler
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
| | - Dominik Müller
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité - University Medicine Berlin, Germany
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10
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Continued reduction in peritonitis rates in pediatric dialysis centers: results of the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative. Pediatr Nephrol 2021; 36:2383-2391. [PMID: 33649895 DOI: 10.1007/s00467-021-04924-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/14/2020] [Accepted: 01/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND In its first 3 years, the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative demonstrated a statistically significant increase in the likelihood of compliance with a standardized follow-up care bundle and a significant reduction in peritonitis. We sought to determine if compliance with care bundles and low peritonitis rates could be sustained in centers continuously participating for 84 months. METHODS Centers that participated from collaborative launch through the 84-month study period and provided pre-launch peritonitis rates were included. Children on maintenance peritoneal dialysis were eligible for enrollment. Changes in bundle compliance were assessed using a logistic regression model or a generalized linear mixed model (GLMM). Changes in average annualized peritonitis rates over time were modeled using GLMMs. RESULTS Nineteen centers contributed 1055 patients with 1268 catheters and 17,247 follow-up encounters. The likelihood of follow-up compliance increased significantly over the study period (OR 1.05 95% confidence interval (CI) 1.03, 1.07; p < 0.001). Centers achieved ≥ 80% follow-up bundle compliance by 28 months and maintained a mean compliance of 84% between 28 and 84 months post-launch. Average monthly peritonitis rates decreased from 0.53 (95% CI 0.37, 0.70) infections per patient-year pre-launch to 0.30 (95% CI 0.23, 0.43) at 84 months post-launch, p < 0.001. CONCLUSIONS Centers participating in the SCOPE Collaborative for 84 months achieved and maintained a high level of compliance with a standardized follow-up care bundle and demonstrated a significant and continued reduction in average monthly peritonitis rates.
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11
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Suzuki R, Sato M, Murakoshi M, Kamae C, Kanamori T, Nishi K, Ogura M, Kamei K. Eosinophilic peritonitis in children on chronic peritoneal dialysis. Pediatr Nephrol 2021; 36:1571-1577. [PMID: 33219843 DOI: 10.1007/s00467-020-04832-9] [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: 07/23/2020] [Revised: 09/11/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Eosinophilic peritonitis (EP) is sometimes difficult to distinguish from bacterial peritonitis (BP) at onset, as they are often overlapping. Previous reports show EP occurs more frequently in infants, although the reason is unknown. METHODS The study population was 77 pediatric patients receiving chronic peritoneal dialysis (PD) in our center. We compared clinical and laboratory data at onset of EP with those of BP. We also investigated age distribution at onset of EP and PD-related surgery. RESULTS Eleven patients developed EP (18 episodes) and 19 patients developed BP (38 episodes). EP patients showed lower rate of cloudy dialysate (44.4% vs. 74.4%; p = 0.04), lower rate of fever (38.9% vs. 56.4%), lower frequency of abdominal pain (16.7% vs. 38.5%), higher peripheral blood eosinophil counts (/μL) (514 vs. 160; p < 0.001), and lower serum C-reactive protein level (mg/dL) (0.4 vs. 4.7; p < 0.001) than BP patients. Thirteen EP events were observed after 169 surgical interventions. Age at surgery-related EP was similar to age at surgery without EP (2.6 vs. 2.1; p = 0.65). There was no significant difference in postoperative EP occurrence between groups <2 years and ≥ 2 years (6.2% vs. 9.1%; p = 0.48). However, infants received more operations than older children. CONCLUSION Clinical symptoms in children and laboratory data of EP in children were less severe than those of BP. As incidence of postoperative EP did not differ by age, we speculate that higher incidence of EP in infants might be associated with higher incidence of surgery, although further validation is necessary.
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Affiliation(s)
- Ryutaro Suzuki
- 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
| | - Miki Murakoshi
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Chikako Kamae
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Toru Kanamori
- 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
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
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12
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Coccia PA, Ramírez FB, Suárez ADC, Alconcher LF, Balestracci A, García Chervo LA, Principi I, Vázquez A, Ratto VM, Planells MC, Montero J, Saurit M, Gutiérrez MGPY, Puga MC, Isern EM, Bettendorff MC, Boscardin MV, Bazán M, Polischuk MA, De Sarrasqueta A, Aralde A, Ripeau DB, Leroy DC, Quijada NE, Escalante RS, Giordano MI, Sánchez C, Selva VS, Caminiti A, Ojeda JM, Bonany P, Morales SE, Allende D, Arias MA, Exeni AM, Geuna JD, Arrúa L. Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience. Pediatr Nephrol 2021; 36:1597-1606. [PMID: 33394193 DOI: 10.1007/s00467-020-04876-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/30/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Management of acute kidney injury (AKI) in children with hemolytic uremic syndrome induced by a Shiga toxin-producing Escherichia coli infection (STEC-HUS) is supportive; however, 40 to 60% of cases need kidney replacement therapy (KRT). The aim of this study was to analyze procedure complications, especially peritonitis, and clinical outcomes in children with AKI secondary to STEC-HUS treated with acute PD. METHODS This is a multicenter retrospective study conducted among thirty-seven Argentinian centers. We reviewed medical records of 389 children with STEC-HUS hospitalized between January 2015 and February 2019 that required PD. RESULTS Complications associated with PD were catheter malfunction (n = 93, 24%), peritonitis (n = 75, 19%), fluid leaks (n = 45, 11.5%), bleeding events (n = 23, 6%), and hyperglycemia (n = 8, 2%). In the multivariate analysis, the use of antibiotic prophylaxis was independently associated with a decreased risk of peritonitis (hazard ratio 0.49, IC 95% 0.29-0.81; p = 0.001), and open-surgery catheter insertion was independently associated with a higher risk (hazard ratio 2.8, IC 95% 1.21-6.82; p = 0.001). Discontinuation of PD due to peritonitis, severe leak, or mechanical complications occurred in 3.8% of patients. No patient needed to be transitioned to other modality of KRT due to inefficacy of the technique. Mortality during the acute phase occurred in 2.8% patients due to extrarenal complications (neurological and cardiac involvement), not related to PD. CONCLUSIONS Acute PD was a safe and effective method to manage AKI in children with STEC-HUS. Prophylactic antibiotics prior to insertion of the PD catheter should be considered to decrease the incidence of peritonitis.
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Affiliation(s)
- Paula A Coccia
- Division of Pediatric Nephrology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Flavia B Ramírez
- Pediatric Department, Hospital Provincial Dr. Castro Rendon, Neuquen, Argentina
| | - Angela D C Suárez
- Department of Pediatric Nephrology, Hospital de Niños Sor María Ludovica, La Plata, Buenos Aires, Argentina
| | - Laura F Alconcher
- Division of Pediatric Nephrology, Hospital Dr. José Penna, Bahía Blanca, Argentina
| | - Alejandro Balestracci
- Division of Pediatric Nephrology, Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Laura A García Chervo
- Department of Nephrology, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Iliana Principi
- Department of Pediatric Nephrology, Hospital Pediátrico Humberto J Notti, Mendoza, Argentina
| | - Aída Vázquez
- Department of Pediatric Nephrology, Hospital Municipal del Niño, San Justo, Buenos Aires, Argentina
| | - Viviana M Ratto
- Department of Pediatric Nephrology, Hospital de Niños Dr. Ricardo Gutierrez, Buenos Aires, Argentina
| | - María Celia Planells
- Department of Pediatric Nephrology, Hospital de Niños de la Santísima Trinidad, Cordoba, Argentina
| | - Jorge Montero
- Department of Pediatric Nephrology, Hospital Materno Infantil de Mar del Plata, Buenos Aires, Argentina
| | - Mariana Saurit
- Pediatric Nephrology Department Hospital Materno Infantil, Salta, Argentina
| | | | - María Celeste Puga
- Department of Clinical Investigation, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Elsa M Isern
- Division of Pediatric Nephrology, Hospital Nacional Profesor Dr. Alejandro Posadas, Buenos Aires, Argentina
| | | | | | - Marta Bazán
- Pediatric Nephrology Unit, Hospital Pediátrico del Niño Jesús, Cordoba, Argentina
| | - Mario A Polischuk
- Pediatric Intensive Care Unit, Clínica Pediátrica San Lucas, Neuquen, Argentina
| | | | - Adriana Aralde
- Division of Pediatric Nephrology, Hospital del Niño Jesús, Tucuman, Argentina
| | - Diego B Ripeau
- Department of Pediatrics, Sanatorio de la Trinidad de Palermo, Buenos Aires, Argentina
| | - Daniela C Leroy
- Department of Pediatrics, Hospital Interzonal de Agudos, Junin, Buenos Aires, Argentina
| | - Nahir E Quijada
- Division of Pediatric Nephrology, Hospital Infantil Municipal, Cordoba, Argentina
| | - Romina S Escalante
- Pediatric Nephrology Unit, Hospital Provincial de Rosario, Santa Fe, Argentina
| | - Marta I Giordano
- Department of Pediatrics, Complejo Sanitario San Luis, San Luis, Argentina
| | - Cristian Sánchez
- Department of Pediatric Nephrology, Hospital Juan Pablo II, Corrientes, Argentina
| | - Verónica S Selva
- Department of Pediatrics Clinica, Universitaria Reina Faviola, Cordoba, Argentina
| | | | - José María Ojeda
- Department of Pediatrics, Hospital de la Madre y el Niño, La Rioja, Argentina
| | - Pablo Bonany
- Department of Pediatrics, Dr. Lucio Molas, Santa Rosa, La Pampa, Argentina
| | - Sandra E Morales
- Department of Pediatrics, Hospital Pediátrico Dr Fernando Barreyro, Posadas, Misiones, Argentina
| | - Daniel Allende
- Department of Pediatrics, Policlínico de Neuquen, Neuquen, Argentina
| | - María Andrea Arias
- Department of Pediatric Nephrology, Hospital Materno Infantil Dr. Héctor Quintana Jujuy, San Salvador de Jujuy, Argentina
| | - Andrea M Exeni
- Division of Pediatric Nephrology, Hospital Austral, Pilar, Buenos Aires, Argentina
| | - Jésica D Geuna
- Division of Pediatric Nephrology, Hospital de Niños Victor J. Vilela, Rosario, Santa Fe, Argentina
| | - Larisa Arrúa
- Department of Pediatrics, Hospital Pediátrico Dr Avelino Castellan, Resistencia, Chaco, Argentina
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13
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Ranchin B, Plaisant F, Demède D, Guillebon J, Javouhey E, Bacchetta J. Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed. Acta Paediatr 2021; 110:781-788. [PMID: 33373057 DOI: 10.1111/apa.15539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/28/2022]
Abstract
AIM Our aim was to look at the technical, ethical and global issues related to neonatal dialysis. METHODS We performed a PubMed research on manuscripts published from March 2010 to March 2020 and retrospectively reviewed all neonates who received dialysis in our French paediatric and neonatal intensive care units from April 2009 to March 2019. RESULTS Dialysis is performed on neonates with pre-existing renal diseases, acute kidney injuries or inborn errors of metabolism. It is required in 0.5%-1% of neonates admitted to the neonatal intensive care units. Peritoneal dialysis and extracorporeal blood purification are both feasible, with more complications, but the results are close to those obtained in older infants, at least in children without multi-organ dysfunction. Novel haemodialysis machines are being evaluated. Ethical issues are a major concern. Multidisciplinary teams should consider associated comorbidities, risks of permanent end-stage renal disease and provide parents with full and neutral information. These should drive decisions about whether dialysis is in child's best interests. CONCLUSION Neonatal dialysis is technically feasible, but ethically challenging, and short-term and long-term data remain limited. Prospective studies and dialysis registries would improve global management and quality of life of these patients at risk of chronic kidney disease.
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Affiliation(s)
- Bruno Ranchin
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Franck Plaisant
- Service de Néonatologie et réanimation néonatale Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Delphine Demède
- Service de Chirurgie Pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Jean‐Marie Guillebon
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
| | - Etienne Javouhey
- Service de Réanimation pédiatrique Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
- Faculté de Médecine Lyon Est Université de Lyon Lyon France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rénales Rares Hôpital Femme Mère Enfant Hospices Civils de Lyon Bron France
- Faculté de Médecine Lyon Est Université de Lyon Lyon France
- INSERM UMR 1033 Faculté de Médecine Lyon Est Université de Lyon Lyon France
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14
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Rees L, Shaw V, Qizalbash L, Anderson C, Desloovere A, Greenbaum L, Haffner D, Nelms C, Oosterveld M, Paglialonga F, Polderman N, Renken-Terhaerdt J, Tuokkola J, Warady B, Walle JVD, Shroff R. Delivery of a nutritional prescription by enteral tube feeding in children with chronic kidney disease stages 2-5 and on dialysis-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol 2021; 36:187-204. [PMID: 32728841 PMCID: PMC7701061 DOI: 10.1007/s00467-020-04623-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 12/14/2022]
Abstract
The nutritional prescription (whether in the form of food or liquid formulas) may be taken orally when a child has the capacity for spontaneous intake by mouth, but may need to be administered partially or completely by nasogastric tube or gastrostomy device ("enteral tube feeding"). The relative use of each of these methods varies both within and between countries. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPRs) based on evidence where available, or on the expert opinion of the Taskforce members, using a Delphi process to seek consensus from the wider community of experts in the field. We present CPRs for delivery of the nutritional prescription via enteral tube feeding to children with chronic kidney disease stages 2-5 and on dialysis. We address the types of enteral feeding tubes, when they should be used, placement techniques, recommendations and contraindications for their use, and evidence for their effects on growth parameters. Statements with a low grade of evidence, or based on opinion, must be considered and adapted for the individual patient by the treating physician and dietitian according to their clinical judgement. Research recommendations have been suggested. The CPRs will be regularly audited and updated by the PRNT.
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Affiliation(s)
- Lesley Rees
- The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK.
| | - Vanessa Shaw
- grid.83440.3b0000000121901201The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK ,grid.11201.330000 0001 2219 0747University of Plymouth, Plymouth, UK
| | - Leila Qizalbash
- Great Northern Children’s Hospital, Upon Tyne, Newcastle, UK
| | - Caroline Anderson
- grid.430506.4Southampton Children’s Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - An Desloovere
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Laurence Greenbaum
- grid.428158.20000 0004 0371 6071Emory University and Children’s Healthcare of Atlanta, Atlanta, USA
| | - Dieter Haffner
- grid.10423.340000 0000 9529 9877Children’s Hospital, Hannover Medical School, Hannover, Germany
| | - Christina Nelms
- grid.24434.350000 0004 1937 0060PedsFeeds LLC, University of Nebraska, Lincoln, USA
| | - Michiel Oosterveld
- grid.414503.70000 0004 0529 2508Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Fabio Paglialonga
- grid.414818.00000 0004 1757 8749Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nonnie Polderman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital, Vancouver, Canada
| | - José Renken-Terhaerdt
- grid.7692.a0000000090126352Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jetta Tuokkola
- grid.7737.40000 0004 0410 2071Children’s Hospital and Clinical Nutrition Unit, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Bradley Warady
- grid.239559.10000 0004 0415 5050Children’s Mercy, Kansas City, USA
| | - Johan Van de Walle
- grid.410566.00000 0004 0626 3303University Hospital Ghent, Ghent, Belgium
| | - Rukshana Shroff
- grid.83440.3b0000000121901201The Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust and Institute of Child Health, University College Londonfig, WC1N 3JH, London, UK
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15
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Dachy A, Bacchetta J, Sellier-Leclerc AL, Bertholet-Thomas A, Demède D, Cochat P, Nobili F, Ranchin B. Long-term outcomes of peritoneal dialysis started in infants below 6 months of age: An experience from two tertiary centres. Nephrol Ther 2020; 16:424-430. [PMID: 33177015 DOI: 10.1016/j.nephro.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Little data are available for infants who started renal replacement therapy before 6 months of age. Because of extra-renal comorbidities and uncertain outcomes, whether renal replacement therapy in neonates is justified remains debatable. METHODS We performed a retrospective analysis of all patients who began chronic peritoneal dialysis below 6 months between 2007 and 2017 in two tertiary centres. Results are presented as median (min;max). RESULTS Seventeen patients (10 boys) were included (8 prenatal diagnoses, 6 premies), with the following diagnoses: congenital anomalies of kidney and urinary tract (n=9), oxalosis (n=5), congenital nephrotic syndrome (n=2) and renal vein thrombosis (n=1). Five patients had associated comorbidities. At peritoneal dialysis initiation, age was 2.6 (0.1;5.9) months, height-standard deviation score (SDS) -1.3 (-5.7;1.6) and weight-SDS -1.4 (-3.6;0.6). Peritoneal dialysis duration was 12 (2;32) months, and at peritoneal dialysis discontinuation height-SDS was -1.0 (-4.3;0.7) weight-SDS -0.7 (-3.2;0.2), parathyroid hormone 123 (44;1540) ng/L, and hemoglobin 110 (73;174) g/L. During the first 6 months of peritoneal dialysis, the median time of hospitalisation stay was 69 (15;182) days. Ten patients presented a total of 27 peritonitis episodes. Reasons for peritoneal dialysis discontinuation were switch to hemodialysis (n=6), transplantation (n=6), recovery of renal function (n=2) and death (n=1). After a follow-up of 4.3 (1.7;10.3) years, 12 patients were transplanted, 2 patients were still on peritoneal dialysis, 2 patients were dialysis free with severe chronic kidney disease and 1 patient had died. Seven patients displayed neurodevelopmental delay, of whom five needed special schooling. CONCLUSION We confirm that most infants starting peritoneal dialysis before 6 months of age will be successfully transplanted and will have a favourable growth outcome. Their quality of life will be impacted by recurrent hospitalisations and neurodevelopmental delay is frequent.
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Affiliation(s)
- Angélique Dachy
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Justine Bacchetta
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm, UMR 1033, faculté de médecine Lyon est, université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Faculté de médecine Lyon est, université de Lyon, Lyon, France
| | - Anne-Laure Sellier-Leclerc
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Aurélia Bertholet-Thomas
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Delphine Demède
- Service de chirurgie pédiatrique, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France
| | - Pierre Cochat
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Inserm, UMR 1033, faculté de médecine Lyon est, université Claude-Bernard Lyon 1, 43, boulevard du 11-novembre-1918, 69622 Villeurbanne cedex, France; Faculté de médecine Lyon est, université de Lyon, Lyon, France
| | - François Nobili
- Service de néphrologie pédiatrique, centre hospitalier régional universitaire de Besançon, Besançon, France
| | - Bruno Ranchin
- Centre de référence des maladies rénales rares, hôpital femme-mère-enfant, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France.
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16
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Barajas-Colon E, Warady BA. Streptococcus salivarius peritonitis in an infant receiving chronic peritoneal dialysis. Perit Dial Int 2020; 41:341-343. [PMID: 33084495 DOI: 10.1177/0896860820964285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Peritonitis is the most common infectious complication of chronic peritoneal dialysis in children and the most common reason for hospitalization. Although the most common organisms responsible for peritonitis are gram-positive bacteria, peritonitis has not previously been reported secondary to Streptococcus salivarius, one of the 26 species in the Streptococcus viridians group. We describe a 4-month-old male who developed S. salivarius peritonitis while receiving automated peritoneal dialysis and who was successfully treated with a 14-day course of intraperitoneal vancomycin. Subtyping episodes of S. viridans-related infection is essential for the identification of S. salivarius.
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Affiliation(s)
- Edgar Barajas-Colon
- Nephrology Department, 61670Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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17
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End-stage kidney disease in infancy: an educational review. Pediatr Nephrol 2020; 35:229-240. [PMID: 30465082 PMCID: PMC6529305 DOI: 10.1007/s00467-018-4151-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 11/05/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
An increasing number of infants with end-stage kidney disease (ESKD) are surviving and receiving renal replacement therapy (RRT). Unique clinical issues specific to this age group of patients influence their short- and long-term outcomes. This review summarizes current epidemiology, clinical characteristics, ethical dilemmas, management concerns, and outcomes of infants requiring chronic dialysis therapy. Optimal care during infancy requires a multidisciplinary team working closely with the patient's family. Nutritional management, infection prevention, and attention to cardiovascular status are important treatment targets. Although mortality rates remain higher among infants on dialysis compared to older pediatric dialysis patients, outcomes have improved over time. Most importantly, infants who subsequently receive a kidney transplant are now experiencing graft survival rates that are comparable to older pediatric patients.
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18
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Colostomy in children on chronic peritoneal dialysis. Pediatr Nephrol 2020; 35:119-126. [PMID: 31673828 DOI: 10.1007/s00467-019-04372-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy. METHODS Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites. RESULTS Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis. CONCLUSION Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.
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19
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Safety of Laparoscopic Gastrostomy in Children Receiving Peritoneal Dialysis. J Surg Res 2019; 244:460-467. [DOI: 10.1016/j.jss.2019.06.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/13/2019] [Accepted: 06/20/2019] [Indexed: 11/18/2022]
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20
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Risk factors for early onset peritonitis: the SCOPE collaborative. Pediatr Nephrol 2019; 34:1387-1394. [PMID: 30969363 DOI: 10.1007/s00467-019-04248-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/01/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred chronic dialysis modality amongst pediatric patients. Peritonitis is a devastating complication of PD. Adult data demonstrates early onset peritonitis (EP) is associated with higher rates of subsequent peritonitis and technique failure. Limited data exists regarding EP in the pediatric population, here defined as peritonitis occurring within 60 days of catheter insertion. METHODS PD catheter insertion practices and EP episodes were examined from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative database. RESULTS There were 98 episodes of EP amongst 1106 PD catheters inserted. Multivariable analysis demonstrated a significant association between early use of the PD catheter and EP (P = 0.001). Age less than 1 year at the time of catheter insertion (P < 0.001), first catheter placed (P < 0.001) for the patient, use of a plastic adapter (P = 0.003), placement of sutures at the exit site (ES) (P = 0.032), and dressing change prior to 7 days post-operatively (P < 0.001) were all significantly associated with early PD catheter use. Concurrent placement of a hemodialysis catheter was associated with a decreased risk for early PD catheter use (P = 0.010). CONCLUSIONS In this large cohort of pediatric PD recipients, 8.4% of PD catheters were associated with the development of EP. The finding of an association between early use of the PD catheter and EP represents a potentially modifiable risk factor to reduce infection rates within this patient population.
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Imani PD, Carpenter JL, Bell CS, Brandt ML, Braun MC, Swartz SJ. Peritoneal dialysis catheter outcomes in infants initiating peritoneal dialysis for end-stage renal disease. BMC Nephrol 2018; 19:231. [PMID: 30217181 PMCID: PMC6137733 DOI: 10.1186/s12882-018-1015-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 08/24/2018] [Indexed: 12/16/2022] Open
Abstract
Background End-stage renal disease (ESRD) although rare among infants presents many management challenges. We sought to evaluate factors associated with PD catheter failure among infants initiated on chronic PD. Methods A retrospective chart review of all children under two years of age who had PD catheters placed for initiation of chronic PD from 2002 to 2015. Data was extracted for catheter related events occurring within 12 months of catheter placement. Cox and Poisson regression models were used to delineate factors associated catheter complications. Results Twenty-five infants with median age 18 days had PD catheters placed for chronic dialysis. Common complications included leakage around the exit site (31%), blockage (26%), migration or malposition (23%), catheter-related infections (18%), and other complications (2%). Predictors of initial PD catheter failure were age less than one month at catheter placement (hazard ratio (HR) 7.77, 95% CI, 1.70–35.39, p = 0.008), use of catheter within three days of placement (HR 5.67, 95% CI, 1.39–23.10, p = 0.015) and presence of a hernia (HR 8.64, 95% CI, 1.19–62.36, p = 0.033). In an adjusted Poisson regression model, PD catheter use within three days of placement was the only predictor of any catheter complication over the12 months of follow up. Conclusions Use of PD catheters within three days of placement was associated with catheter failure. We recommend that when possible, catheters should be allowed to heal for at least three days prior to use to reduce risk of complications and improve catheter survival.
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Affiliation(s)
- Peace D Imani
- Renal Section, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA.
| | - Jennifer L Carpenter
- Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA
| | - Cynthia S Bell
- Division of Pediatric Nephrology and Hypertension, McGovern Medical School at UTHealth, 6431 Fannin St, MSB 3.121, Houston, TX, 77030, USA
| | - Mary L Brandt
- Department of Surgery, Texas Children's Hospital/Baylor College of Medicine, 6621 Fannin St, Houston, TX, 77030, USA
| | - Michael C Braun
- Renal Section, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
| | - Sarah J Swartz
- Renal Section, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, 1102 Bates Avenue, Suite 245, Houston, TX, 77030, USA
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Munshi R, Sethna CB, Richardson T, Rodean J, Al-Akash S, Gupta S, Neu AM, Warady BA. Fungal peritonitis in the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative. Pediatr Nephrol 2018; 33:873-880. [PMID: 29313137 DOI: 10.1007/s00467-017-3872-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 11/12/2017] [Accepted: 12/02/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fungal peritonitis is a serious complication among peritoneal dialysis (PD) patients. The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multicenter quality improvement initiative with the primary aim to reduce catheter-related infections in children on chronic dialysis. OBJECTIVE To describe the epidemiology of fungal peritonitis and outcomes of affected patients among pediatric subjects receiving chronic PD and enrolled in SCOPE. METHODS Data pertaining to PD characteristics, peritonitis episodes and patient outcome were collected between October 2011 and September 2015 from 30 pediatric dialysis centers participating in the SCOPE collaborative. Peritonitis-related data were stratified by etiology, fungal versus bacterial/culture-negative peritonitis. Differences among groups were assessed by Chi-square analysis. RESULTS Of 994 patients enrolled in the registry, there were 511 peritonitis episodes of which 41 (8.0%) were fungal. Thirty-six individual patients with 39 unique catheters accounted for the fungal peritonitis episodes. Twenty-three (59%) of the episodes occurred in patients aged < 2 years (p = 0.03). Fungal peritonitis was the initial episode of peritonitis in 48.8% of affected patients, and only 17.1% of these patients had had a previous peritonitis episode within 30 days of the fungal infection. Insertion of the PD catheter at < 2 years of age was associated with an adjusted odds ratio of 2.8 (95% confidence interval 1.24, 6.31) for development of fungal peritonitis compared to older children (p = 0.01). Fungal peritonitis was associated with an increased rate of hospitalization (80.5 vs. 63.4%; p = 0.03), increased length of hospitalization (median of 8 vs. 5 days; p < 0.001) and increased rates of catheter removal (84.6 vs 26.9%; p = 0.001) and technique failure (68.3 vs. 8%; p = 0.001) compared to other causes of peritonitis. CONCLUSION Fungal infections were responsible for 8.0% of peritonitis episodes in the SCOPE collaborative, with the majority of fungal peritonitis episodes occurring in children aged < 2 years. Although no risk factors for infection other than young age were identified, fungal peritonitis was associated with an increased risk of hospitalization, longer hospital stay and an increased frequency of technique failure.
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Affiliation(s)
- Raj Munshi
- Pediatric Nephrology, Seattle Children's, Seattle, WA, USA.
| | - Christine B Sethna
- Pediatric Nephrology, Cohen Children's Medical Center of New York, New Hyde Park, NY, USA
| | - Troy Richardson
- Biostatistics, Children's Hospital Association, Lenexa, KS, USA
| | - Jonathan Rodean
- Biostatistics, Children's Hospital Association, Lenexa, KS, USA
| | - Samhar Al-Akash
- Pediatric Nephrology, Driscoll Children's Hospital, Corpus Christi, TX, USA
| | - Sushil Gupta
- Pediatric Nephrology, University of Louisville, Louisville, KY, USA
| | - Alicia M Neu
- Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bradley A Warady
- Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO, USA
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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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