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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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Aujo JC, Coetzee A, Masu A, Enimil A, Luyckx VA, Nourse PJ, McCulloch MI. Discontinuation of maintenance peritoneal dialysis in children-A 10-year review from a single center in a low resource setting. Perit Dial Int 2024:8968608241259608. [PMID: 38863313 DOI: 10.1177/08968608241259608] [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: 06/13/2024] Open
Abstract
INTRODUCTION In South Africa, only children considered eligible for transplantation are offered dialysis as bridge to kidney transplantation. Maintenance peritoneal dialysis (PD) is preferred and has several advantages over hemodialysis (HD). While awaiting transplantation, PD may be discontinued due to permanent transfer to HD or death while on PD, of which the occurrence and burden is not known in our setting. We investigated the rate of discontinuation of maintenance PD, and associated factors among children awaiting a kidney transplant under challenging socio-economic circumstances in a low resource setting. METHODS Single center retrospective analysis of children receiving maintenance PD. Outcomes included the proportion of children who discontinued PD before transplantation, associated factors and timing of discontinuation, and the proportion transplanted. Time to discontinuation or transplantation was displayed using a Kaplan-Meier curve. RESULTS Sixty-seven children who received maintenance automated PD as initial dialysis modality were identified from the kidney transplant waiting list between January 2009 and December 2018. Complete data was available for 52 of the 67 children. Four children had prior failed kidney transplants. The median age was 11 years (interquartile range 6.0, 13.1). Overall, 17/52 (32.7%) children discontinued PD, with 13 (25%) transfers to HD and 4 deaths (7.7%), whereas 29/52 (55.8%) received a kidney transplant. Three of the deaths were PD related. Six children remained on maintenance PD at the end of the study period. Over a half of our patients discontinued PD by 12 months, and 80% by 30 months. Most PD discontinuations were associated with peritonitis. CONCLUSIONS The proportion discontinuing PD was high, highlighting the need to optimize measures to improve retention rates, especially through prevention of peritonitis.
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Affiliation(s)
- Judith Caroline Aujo
- Department of Pediatrics and Child Health, Mulago National Referral Hospital, Kampala, Uganda
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Ashton Coetzee
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Adelaide Masu
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Anthony Enimil
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Department of Child Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Valerie A Luyckx
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Peter J Nourse
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
| | - Mignon I McCulloch
- Department of Pediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa
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Pangonis SF, Schaffzin JK, Claes D, Mortenson JE, Nehus E. An initiative to improve effluent culture detection among pediatric patients undergoing peritoneal dialysis through process improvement. Pediatr Nephrol 2023; 38:211-218. [PMID: 35445978 PMCID: PMC9021362 DOI: 10.1007/s00467-022-05533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Peritonitis is a significant cause of morbidity and healthcare cost among pediatric patients undergoing peritoneal dialysis. Culture-negative peritonitis has been associated with an increased risk of technique failure. Known risk factors for culture-negative peritonitis are related to the process of collection and sample processing for culture, but additional studies are needed. A culture detection rate of 16.7% was identified among our patients undergoing peritoneal dialysis, which is below the national benchmark of ≥ 85%. Our primary objective of this quality improvement project was to improve culture detection rates. METHODS Interventions were developed aimed at standardizing the process of effluent collection and laboratory processing, timely collection and processing of samples, and addressing other modifying risk factors for lack of bacterial growth from culture. These interventions included direct inoculation of effluent into blood culture bottles at bedside and use of an automated blood culture system. Two Plan-Do-Study-Act cycles were completed prior to moving to the sustain phase. RESULTS The culture detection rate improved from 16.7% (pre-intervention) to 100% (post-intervention). A decrease in the median process time also occurred from 83 min (pre-intervention) to 53 min (post-intervention). An individual and moving range chart identified a decrease in both the centerline (mean) and upper control limit, indicating that the process became more reliable during the sustain phase. CONCLUSIONS An improvement in process time and culture positivity rate occurred following standardization of our PD fluid culture process. Future studies should be aimed at the impact of the components of collection and processing methods on the effluent culture yield. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Scott F. Pangonis
- Department of Pediatrics, Children’s Medical Center of Akron, Akron, OH 44308 USA
| | - Joshua K. Schaffzin
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Donna Claes
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Joel E. Mortenson
- grid.24827.3b0000 0001 2179 9593Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229 USA
| | - Edward Nehus
- grid.36425.360000 0001 2216 9681Department of Pediatrics, Marshall University Joan C Edwards School of Medicine, Huntington, WV 25701 USA
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Reduction in peritonitis rates: 18-year results from the most active pediatric peritoneal dialysis center in China. Pediatr Nephrol 2022; 37:2437-2448. [PMID: 35166916 DOI: 10.1007/s00467-022-05450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/26/2021] [Accepted: 12/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Most of the available epidemiological data on peritonitis have been derived from developed countries. Limited data from China have been reported. METHODS An 18-year (2001-2018) peritoneal dialysis (PD) program at the Children's Hospital of Fudan University was described, and data on peritonitis were retrospectively analyzed. RESULTS Since 2001, a program with a comprehensive PD care bundle has been developed, and 283 patients (53.7% male, median age 9.3 years) were enrolled between 2001 and 2018. Among these patients, 117 peritonitis episodes occurred in 68 (24.0%) patients over 4896 patient-months. The peritonitis rate decreased 20-fold from 2.2 episodes per patient-year in 2003 to 0.11 episodes in 2018. The culture-negative rate decreased from 68.7% during 2001-2006 to 18.5% during 2013-2018, and the proportion of gram-negative and fungal infections increased significantly from 6.6 to 33.8% and 0 to 9.2%, respectively (p < 0.001). Short stature as height ≤ - 2 SD (OR 2.35, 95% CI 1.30-4.24, p = 0.005) and PD duration ≥ 1 year (OR 3.38, 95% CI 1.76-6.49, p < 0.001) were independently associated with a higher risk of developing peritonitis. Of the 117 peritonitis episodes, 9.4% required permanent removal of the catheter, among which half were fungal infections. Patients with peritonitis had a higher risk for PD technique failure (p = 0.006), but there was no difference in estimated patient survival rates and no patient death due to peritonitis. CONCLUSIONS With the successful development of the PD program and care bundles per the International Society of Pediatric Dialysis (ISPD) guidelines, peritonitis rates have been tremendously reduced in the most active pediatric PD center in China. Growth deficits and a long PD duration were risk factors for developing peritonitis, requiring further close monitoring for a better outcome. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Pınarbaşı AS, Akbalık Kara M. Sociodemographic features and outcomes of peritonitis episodes in children on peritoneal dialysis. Ther Apher Dial 2022; 26:1264-1273. [PMID: 35274466 DOI: 10.1111/1744-9987.13836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Peritoneal dialysis (PD) is one of the most preferred kidney replacement therapies in children. However, it has an important complication such as peritonitis. This study was planned to investigate the causes and frequency of peritonitis in children with PD. METHODS The demographic features, peritonitis episodes and microbiological characteristics of PD patients followed up for 5 years. RESULTS Fifty pediatric PD patients who met the study criteria in a 5-year period were included in the study. Consanguineous marriage was 64% and 44% of the mothers was illiterate. Nineteen patients had no peritonitis episode and a total of 54 peritonitis episode were experienced. The overall peritonitis rate was one episode per 24.4 patient-months. Culture negativity rate was 44%. CONCLUSION Even though factors such as the education level of the parents, the number of people or rooms in the house, dialysis modality were thought to influence peritonitis episodes, they could not be shown statistically. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Mehtap Akbalık Kara
- Pediatric Nephrologist, Department of Pediatrics, Division of Pediatric Nephrology, Gaziantep University
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AlZabli SM, Alsuhaibani MA, BinThunian MA, Alshahrani DA, Al Anazi A, Varghese S, Rose V, Rahim KA. Peritonitis in children on peritoneal dialysis: 12 years of tertiary center experience. Int J Pediatr Adolesc Med 2021; 8:229-235. [PMID: 34401447 PMCID: PMC8356114 DOI: 10.1016/j.ijpam.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 10/27/2022]
Abstract
Background and Objective Peritoneal dialysis (PD) associated peritonitis is the most common cause of morbidity, mortality, and treatment failure in patients undergoing PD. We aimed to identify the incidence, pathogens, antibiotic susceptibility, and the outcome of peritoneal dialysis (PD)-associated peritonitis in children. Methods Data from medical records of children who underwent PD between 2007 and 2018 in King Fahad Medical City were retrospectively collected. All children aged <14 years undergoing chronic PD were included. The demographic characteristics of patients, peritonitis rates, and clinical outcomes were collected. Results In total, 131 children [boys, 68 (51.9%)] underwent automated PD for 305 years. The most common age group was 6-12 years (61 patients, 46.6%). A total of 74.0% of patients were new to dialysis; 25.2% were transferred from hemodialysis. Peritonitis incidence was 0.6 episodes/patient-year. Gram-positive and -negative organisms were identified in 50.1% and 22% episodes, respectively, whereas cultures remained negative in 20.5% episodes. Coagulase-negative Staphylococcus was the most common isolated organism (22.1%), followed by methicillin-sensitive S. aureus (11.1%). Peritonitis was resolved in 153 (73.6%) episodes, whereas 52 (25.0%) episodes required removal through the catheter. The multivariate logistic regression analysis found the exit site infection to be a risk factor for catheter removal. Three (1.4%) episodes caused death due to peritonitis complicated by septic shock. Conclusions Our data showed that the most common organisms causing peritonitis were similar to those reported in the previous international registry. The rate of peritonitis was high, but markedly improved in the past two years.
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Affiliation(s)
- Saeed M AlZabli
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Mohammed A Alsuhaibani
- Department of Pediatrics, College of Medicine, Qassim University, Qassim, 51452, Saudi Arabia
| | - Meshail A BinThunian
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Dayel A Alshahrani
- General Pediatric Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Abdulkarim Al Anazi
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Sibi Varghese
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Vernice Rose
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
| | - Khawla A Rahim
- Pediatric Nephrology Section, Children Specialized Hospital, King Fahad Medical City, Riyadh, 12231, Saudi Arabia
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Davis TK, Bryant KA, Rodean J, Richardson T, Selvarangan R, Qin X, Neu A, Warady BA. Variability in Culture-Negative Peritonitis Rates in Pediatric Peritoneal Dialysis Programs in the United States. Clin J Am Soc Nephrol 2021; 16:233-240. [PMID: 33462084 PMCID: PMC7863662 DOI: 10.2215/cjn.09190620] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES International guidelines suggest a target culture-negative peritonitis rate of <15% among patients receiving long-term peritoneal dialysis. Through a pediatric multicenter dialysis collaborative, we identified variable rates of culture-negative peritonitis among participating centers. We sought to evaluate whether specific practices are associated with the variability in culture-negative rates between low- and high-culture-negative rate centers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Thirty-two pediatric dialysis centers within the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative contributed prospective peritonitis data between October 1, 2011 and March 30, 2017. Clinical practice and patient characteristics were compared between centers with a ≤20% rate of culture-negative peritonitis (low-rate centers) and centers with a rate >20% (high-rate centers). In addition, centers completed a survey focused on center-specific peritoneal dialysis effluent culture techniques. RESULTS During the 5.5 years of observation, 1113 patients had 1301 catheters placed, totaling 19,025 patient months. There were 620 episodes of peritonitis in 378 patients with 411 catheters; cultures were negative in 165 (27%) peritonitis episodes from 125 (33%) patients and 128 (31%) catheters. Low-rate centers more frequently placed catheters with a downward-facing exit site and two cuffs (P<0.001), whereas high-rate centers had more patients perform dialysis themselves without the assistance of an adult care provider (P<0.001). The survey demonstrated that peritoneal dialysis effluent culture techniques were highly variable across centers. No consistent practice or technique helped to differentiate low- and high-rate centers. CONCLUSIONS Culture-negative peritonitis is a frequent complication of maintenance peritoneal dialysis in children. Despite published recommendations for dialysis effluent collection and culture methods, great variability in culture techniques and procedures exists among individual dialysis programs and respective laboratory processes.
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Affiliation(s)
- T. Keefe Davis
- Department of Pediatrics, Division of Pedatric Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kristina A. Bryant
- Department of Pediatrics, Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
| | | | | | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Kansas City, Kansas City, Missouri
| | - Xuan Qin
- Department of Laboratory Medicine, Division of Microbiology, Seattle Children’s, Seattle, Washington
| | - Alicia Neu
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bradley A. Warady
- Department of Pediatrics, Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, Missouri
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8
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Dao Bui Quy Q, Pham Ngoc Huy T, Nguyen Duc L, Pham Van M, Nguyen Huu D, Nguyen Duy T, Tran Viet T, Do Q, Le Viet T. Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients. BMC Nephrol 2020; 21:512. [PMID: 33238904 PMCID: PMC7690099 DOI: 10.1186/s12882-020-02178-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022] Open
Abstract
Background In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients over a 3-year period. Methods We measured serum prealbumin concentration and OH by body composition monitor in 278 CAPD patients (159 males and 119 females) with a mean age of 46 years and a median peritoneal dialysis (PD) duration of 21 months. Cases of PD-related peritonitis were collected over 3 years. Results After the 3-year follow-up, 44 patients were diagnosed with PD-related peritonitis (15.8%). Low education, serum glucose, prealbumin, and OH were independent risk factors for predicting peritonitis over 36 months in CAPD patients. Based on the ROC curve model and Kaplan-Meier analysis, we realized that low prealbumin and high OH were independent predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se = 90.9%, Sp = 32.9%; OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%; and log-rank test p < 0.001, respectively). Conclusion Overhydration and low serum prealbumin were the independent predictors of PD-related peritonitis in CAPD patients.
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Affiliation(s)
| | | | | | - My Pham Van
- University of Medicine Pham Ngoc Thach, Ho Chi Minh, Viet Nam
| | | | - Toan Nguyen Duy
- Military Hospital 103, Ha Noi, Viet Nam.,Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Tien Tran Viet
- Military Hospital 103, Ha Noi, Viet Nam.,Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Quyet Do
- Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Thang Le Viet
- Military Hospital 103, Ha Noi, Viet Nam. .,Vietnam Military Medical University, Ha Noi, Viet Nam.
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Frehat MQF, Al-Salaita GM, Al-Bderat JT, Alhadidi AM, Mohammad SA, Shaaban AM, Al Mardini R. Chronic peritoneal dialysis in children: a single-centre experience in Jordan. Sudan J Paediatr 2020; 20:34-41. [PMID: 32528199 DOI: 10.24911/sjp.106-1578945921] [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: 11/11/2022]
Abstract
The aim of the present study is to share the experience of chronic peritoneal dialysis (PD) at King Hussein Medical Center, Amman, Jordan, and to highlight the complications of this procedure. This is a retrospective chart review study for all the children from day 1 of life to 14 years, who underwent chronic PD for end-stage renal disease (ESRD) during the period of 10 years extending from 2009 to 2019. The following data were collected: mode of dialysis, type of peritoneal dialysis, age of starting peritoneal dialysis, gender, aetiology of ESRD, duration on PD, complications and outcome. A total number of 269 children were included: 229 patients received haemodialysis and 40 children (22 boys and 18 girls) received PD. Of those, two children were on automated PD and 38 children were on continuous ambulatory peritoneal dialysis. The mean age at the start of PD was 62 ± 38 months. The mean duration of PD was 43 months. The mean catheter duration was 34 months. Six patients were shifted to haemodialysis permanently and four patients received a kidney transplant. Eleven patients died. The most common complications were peritonitis (52.5%), exit-site infection (30%) and malfunctioning catheter (12.5%). The rate of peritonitis was one episode per 22 patient-months. Peritoneal dialysis is a promising mode of dialysis for children in Jordan. Peritonitis is the most common complication associated with PD. Kidney transplantation is the best modality of renal replacement therapy in terms of long-term survival and quality of life and should be encouraged on national level.
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Affiliation(s)
- Mahdi Qasem Farah Frehat
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Ghazi Mohammad Al-Salaita
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Jwaher Thiab Al-Bderat
- Pediatric Nephrology Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Aghadir Mohammad Alhadidi
- Pediatric Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Samera Adnan Mohammad
- Dialysis Unit, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Ahmad Mohammad Shaaban
- Pediatric Department, Queen Rania Al Abdallah Hospital for Children, King Hussein Medical Center, Amman, Jordan
| | - Reham Al Mardini
- Pediatrics and Pediatric nephrology, Private Practice, Amman, Jordan
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10
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Al Mokali K, Al Sannaa Z, Al Mutairi F, Ahmed AE. Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis. BMC Pediatr 2020; 20:42. [PMID: 31996157 PMCID: PMC6988221 DOI: 10.1186/s12887-020-1936-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/20/2020] [Indexed: 11/12/2022] Open
Abstract
Background The peritonitis rate among children treated with peritoneal dialysis (PD) has not been widely reported in Saudi Arabia. The study aim was to estimate the peritonitis rate per patient-year and investigate the factors associated with higher peritonitis rates in a sample of PD children at King Abdullah Specialist Children’s Hospital-Riyadh (KASCH-R), Saudi Arabia. Methods This retrospective cohort study included 27 PD children treated between September 2007 and December 2017 at KASCH-R. We recorded the children’s demographic and clinical data, and the frequency of peritonitis. Results The 27 PD children reviewed (63% girls; mean age = 7.32 years old; range, 1–14 years), resulted in 86 peritonitis diagnoses in which the overall recurrence rate (in at least one episode) was 58/86 (67.4%) with a 95% confidence interval (CI), 56.5 to 77.2%. The rate of peritonitis episodes per patient-year was 0.76 (1 episode per 1.31 patient-year). The generalized Poisson model identified older children (age > 10 years) (adjusted rate ratios [aRR] = 7.273, 95% CI: 1.562–33.860), congenital nephrosis (aRR = 4.677, 95% CI: 1.443–15.155), height below 3rd percentile (aRR = 4.689, 95% CI: 1.874–11.735), weight below 3rd percentile (aRR = 5.388, 95% CI: 1.678–17.302), low albumin level (aRR = 4.041, 95% CI: 2.053–7.956), two-week duration of antibiotic therapy (aRR = 2.947, 95% CI: 1.163–7.468), which were independently associated with a high peritonitis rate. Conclusions This study showed a high peritonitis rate in our center. Older children, congenital nephrosis, height and weight below the 3rd percentile, low albumin level, and long duration of antibiotic therapy were associated with a higher rate of peritonitis. An optimal peritonitis prevention strategy or best-practice guideline is needed to reduce and prevent peritonitis occurrence in our center.
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Affiliation(s)
- Khamisa Al Mokali
- Division of Nephrology, Department of Paediatrics, King Abdullah Specialist Children's Hospital, Ministry of the National Guard - Health Affairs City, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Faten Al Mutairi
- Maternity and Children Hospital, Madina Al Munawara, Saudi Arabia
| | - Anwar E Ahmed
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA. .,Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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11
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Peluso G, Incollingo P, Carlomagno N, D'Alessandro V, Tammaro V, Caggiano M, Sandoval Sotelo ML, Rupealta N, Candida M, Mazzoni G, Campanile S, Chiacchio G, Scotti A, Santangelo ML. Our Timing to Remove Peritoneal Catheter Dialysis After Kidney Transplant. Transplant Proc 2018; 51:160-163. [PMID: 30655154 DOI: 10.1016/j.transproceed.2018.04.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/13/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients on peritoneal dialysis treatment represent 15% of the global dialysis population. The major complication of peritoneal dialysis is catheter and peritoneal infection. Peritoneal dialysis patients who receive kidney transplants are at increased risk of infection because of immunosuppressive therapy. AIM The purpose of this study is to show our ideal timing to remove peritoneal catheter after kidney transplant, which gives adequate security on renal function recovery and reduction of septic risk. METHOD OF STUDY We analyzed the outcomes of 65 patients on peritoneal dialysis who underwent kidney transplant between 2000 and 2016. RESULTS In 61 cases there was an immediate graft functional recovery. In 4 cases there was a delayed graft function (DGF), and we performed a hemodialysis with temporary placement of a venous catheter. In all patients we removed peritoneal dialysis catheter 30 to 45 days after transplant. There has been 1 case of catheter infection, which was treated with antibiotic therapy. DISCUSSION Our average time to remove the peritoneal dialysis catheter was shorter than times in previous studies, between the 30th and 45th postoperative day. In the 4 cases in which there has been a DGF, we performed hemodialysis treatment to avoid, in the immediate postoperative period, direct insults to the peritoneum by local dialysis procedures. CONCLUSION Our experience show that the 30th to 45th postoperative day is a good time frame, better yet a good watershed between the safe removal of peritoneal catheter when patients have a stabilized renal function and the possibility of leaving it in situ, to resume peritoneal dialysis in case of persistent DGF.
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Affiliation(s)
- G Peluso
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy.
| | - P Incollingo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - N Carlomagno
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - V D'Alessandro
- Kidney Transplantation Center and Retroperitoneal Surgery, University Hospital Federico II of Naples, Naples, Italy
| | - V Tammaro
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M Caggiano
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M L Sandoval Sotelo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - N Rupealta
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M Candida
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - G Mazzoni
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - S Campanile
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - G Chiacchio
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - A Scotti
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
| | - M L Santangelo
- Operative Unit of General Surgery and Kidney Transplantation, Advanced Biomedical Science Department, University Federico II of Naples, Naples, Italy
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