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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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Kara MA, Pinarbasi AS. Outcomes of Maintenance Peritoneal Dialysis in Children: A State Hospital Experience from Southeastern Turkey. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2023; 34:51-60. [PMID: 38092716 DOI: 10.4103/1319-2442.391002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
This study aimed to evaluate the clinical features, laboratory features, and outcomes of pediatric patients on peritoneal dialysis (PD) and compare the factors affecting mortality. The demographic, clinical, and laboratory data of 50 patients on maintenance PD followed up for more than 3 months were retrospectively analyzed for non-survivors and survivors to evaluate all factors affecting mortality. The patients (26 boys and 24 girls) had a mean age of 85.4 ± 58.7 months (range: 1-194 months) at the initiation of PD. The mean duration of dialysis at follow-up was 27.8 ± 21.7 months (range: 3-115 months). The rate of peritonitis was one episode per 27.27 patient months. PD was discontinued because of transplantation in eight patients, death in eight patients, and shifting to hemodialysis in three patients. In the Kaplan-Meier analysis, the 1-year patient survival rate at 1 year, 2 years, and 5 years was 81.8%, 51.7%, and 12.3%, respectively. Non-survivors were significantly younger at the start of kidney replacement therapy, had a final younger age at dialysis, and had lower albumin levels than survivors. We excluded four patients with a follow-up period of <6 months. Cox regression analysis revealed a low albumin status (P = 0.014, hazard ratio: 0.230) and a high level of ferritin (P = 0.002, hazard ratio: 1.002) to be risk factors for mortality. This study showed a high mortality rate. Hypoalbuminemia, a younger age at the start of kidney replacement therapy, and a younger final age at dialysis had a significant association with mortality.
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Affiliation(s)
- Mehtap Akbalik Kara
- Department of Pediatric Nephrology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Ayse Seda Pinarbasi
- Department of Pediatric Nephrology, Diyarbakir Children's Hospital, Diyarbakir, Turkey
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Luo PT, Li W, Li XY, Zhang Y, Du B, Cui WP. Impact of peritoneal dialysis modality on patient and PD survival: A systematic review. ARCH ESP UROL 2022; 43:128-138. [PMID: 36476184 DOI: 10.1177/08968608221140788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77–0.99], p = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63–0.90], p = 0.00), published in Asia (HR 0.76 [95% CI, 0.67–0.86], p < 0.001) or Europe (HR 0.81 [95% CI, 0.74–0.89], p < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68–0.99], p = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], p = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], p = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
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Affiliation(s)
- Pei-Ting Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xin-Yang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yu Zhang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bing Du
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wen-Peng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
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Tiewsoh K, Soni A, Dawman L, Peters NJ, Malik MA. Chronic peritoneal dialysis in children with chronic kidney disease: An experience from a North Indian teaching institute. J Family Med Prim Care 2021; 10:3682-3687. [PMID: 34934666 PMCID: PMC8653466 DOI: 10.4103/jfmpc.jfmpc_250_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic peritoneal dialysis (CPD) is an important modality of renal replacement therapy (RRT) in children of all ages with end-stage renal disease (ESRD). We retrospectively assessed the clinical profile of children with chronic kidney disease (CKD) initiated on CPD at a tertiary care centre in Northern India. MATERIALS AND METHODS Retrospective data of 13 children with CKD and initiated on CPD between 2016 and 2019 were retrieved and analysed. The demographic and clinical profile, aetiology of CKD, method of catheter insertion, mode of dialysis, complications, and catheter survival rate were analysed. RESULTS The median age at the onset of the symptoms was 81 months interquartile range (IQR 11-90) and the median age at the diagnosis was 81 months (IQR 36-103). The median age at the initiation of CPD was 92.97 months (IQR 74.43-108.79). The median serum creatinine at the initiation of CPD was 6.3 mg/dL (IQR 4.25-8.4). During a total study period of 84 CPD months, we observed 16 catheter-related complications and a complication rate of 1 per 5.25 CPD months. The overall peritonitis rate was 1 episode per 13.66 patient-months (0.87 episodes per patient-year). The catheter displacement/migration was seen in 23% of the cases. The median duration of follow-up was 175 days (IQR 85-249) with the longest follow-up duration of 502 days. CONCLUSION CPD is the modality of choice for smaller children with ESRD as venous access is difficult to achieve in smaller children. Complications especially related to infections are a major concern in addition to poor growth associated with ESRD.
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Affiliation(s)
- Karalanglin Tiewsoh
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshita Soni
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lesa Dawman
- Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin J. Peters
- Department of Pediatric Surgery, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muneer A. Malik
- Department of Pediatric Surgery, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alsuhaibani M, Aldosari E, Rahim KA, Alzabli S, Alshahrani D. Fungal peritonitis in children on peritoneal dialysis at a tertiary care Centre. BMC Nephrol 2020; 21:400. [PMID: 32938414 PMCID: PMC7493397 DOI: 10.1186/s12882-020-02014-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fungal peritonitis (FP) is an infrequent but serious complication in children undergoing peritoneal dialysis (PD). This study aimed to explore the risk factors, clinical manifestations, causative organisms, fungal susceptibility findings, and outcomes of FP in children from Saudi Arabia. METHODS In this case-control study, the medical records and laboratory results of paediatric patients aged 0-14 years who underwent PD were reviewed for FP episodes. All FP episodes were matched with PD-related bacterial peritonitis episodes (1:4 ratio). RESULTS A total of 194 episodes of PD-related peritonitis occurred between 2007 and 2017, among which 11 were FP episodes (5.6%), representing a rate of 0.03 episodes per patient-year. Of these 11 episodes, 9 were caused by Candida species (82%). Compared with the bacterial peritonitis group, the FP group had a higher proportion of patients with congenital/infantile nephrotic syndrome (p = 0.005) and those younger than 5 years of age (p = 0.001). We observed a higher rate of catheter removal in the FP group than in the bacterial peritonitis group (p < 0.001); however, 1 patient died despite catheter removal. Moreover, 75% of Candida species isolates were susceptible to fluconazole. CONCLUSIONS This study revealed that FP is associated with a significant risk of peritoneal membrane failure among children undergoing PD. Therefore, early diagnosis and prompt management are essential. We also found that congenital/infantile nephrotic syndrome and young age (5 years old or younger) were risk factors for FP in children undergoing PD.
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Affiliation(s)
- Mohammed Alsuhaibani
- Department of Paediatrics, College of Medicine, Qassim University, P.O. Box 6666, Buraidah, Qassim, 51452, Saudi Arabia. .,Department of Paediatric Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Egab Aldosari
- General Paediatric Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khawla A Rahim
- Department of Paediatric Nephrology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Saeed Alzabli
- Department of Paediatric Nephrology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Dayel Alshahrani
- Department of Paediatric Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
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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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7
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Peng Q, Chen L, Zhou S, Li H, Long J, Yao F, Zhuang Y, Zhang Z, Huang Y, Duan K. Co-existence of Citrobacter freundii exacerbated Pseudomonas aeruginosa infection in vivo. Int J Med Microbiol 2020; 310:151379. [PMID: 31759864 DOI: 10.1016/j.ijmm.2019.151379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/11/2019] [Accepted: 11/10/2019] [Indexed: 02/05/2023] Open
Abstract
The presence of bacterial species other than the pathogen at infection site can affect the progression of a bacterial infection. Based on the fact that Citrobacter freundii can coexist during Pseudomonas aeruginosa infection, this study aims to investigate the impact of the co-existing C. freundii on the pathogenesis of P. aeruginosa infection. A murine peritonitis model was used to compare the mortality rates and histopathology of P. aeruginosaPAO1 infection in the presence and absence of a C. freundii clinical isolate C9. We also investigated the intercellular interaction between PAO1 and C9 by examining pyocyanin production and comparing gene expression levels. The results demonstrate that co-infection with C9 significantly increased the mortality rate and tissue damages in PAO1 infected mice. At an inoculum of 106 CFU, no mortality was observed in the C9 infected group at three days post-infection, whereas the mortality rate in the PAO1-C9 co-infection group was 64%, compared with 24% in the PAO1 infected group. Pyocyanin production in P. aeruginosa PAO1 increased 8 folds approximately in the presence of C. freundii C9, and operons associated with phenazine synthesis, phzA1 and phzA2, were also upregulated. Disruption of the phzA1 and phzA2 eliminated the exacerbated pathogenicity in the co-infection group, indicating that the elevated pyocyanin production was the main contributing factor. The results suggest that co-existing C. freundii during P. aeruginosa infection can exacerbate the pathogenicity, which may have significant implications in patients infected with these bacteria.
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Affiliation(s)
- Qing Peng
- Department of Hepatobiliary Surgery II, Institute of Regenerative Medicine, Zhujiang Hospital of Southern Medical University, Guangzhou, China; Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada
| | - Lin Chen
- Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada; Faculty of Life Sciences, Northwest University, 229 Taibai Rd. North, Xi'an, Shaanxi, China
| | - Shuqin Zhou
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Haiyan Li
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Jun Long
- Department of Clinical Laboratory, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Fen Yao
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Yijing Zhuang
- Department of Clinical Laboratory, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Zijie Zhang
- Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China
| | - Yuanchun Huang
- Department of Clinical Laboratory, the first affiliated hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Kangmin Duan
- Department of Medical Microbiology and Infectious Diseases & Oral Biology, Rady Faculty of Health Sciences, University of Manitoba, 780 Bannatyne Ave, Winnipeg, MB R3E 0W2, Canada.
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Prasad N, Rangaswamy D, Patel M, Gulati S, Bhadauria D, Kaul A, Gupta A. Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study from a developing country. Pediatr Nephrol 2019; 34:2389-2397. [PMID: 31468143 DOI: 10.1007/s00467-019-04311-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. METHODS To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. RESULTS A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months). CONCLUSION CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Dharshan Rangaswamy
- Department of Nephrology (Pediatric), Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal (Udupi), 576104, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Sanjeev Gulati
- Pediatric Nephrology, Fortis Group of Hospitals, New Delhi, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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The rate of PD catheter complication does not increase with simultaneous abdominal surgery. J Pediatr Surg 2018; 53:1499-1503. [PMID: 29249456 DOI: 10.1016/j.jpedsurg.2017.11.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 09/24/2017] [Accepted: 11/18/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Children with kidney failure requiring PD catheter placement often require additional intraabdominal surgery. However, the risk of complication related to simultaneous abdominal surgery at time of catheter placement is unknown. METHODS Patients (0-18years) who underwent PD catheter placement (2012-2015) in the NSQIP-P database were reviewed. Complication rates between patients who underwent additional abdominal surgery at the time of PD catheter placement and those that did not were evaluated. One to one case control matching was performed for additional adjusted analysis. RESULTS Of 563 patients who met inclusion criteria, 82 underwent simultaneous abdominal surgery at time of PD catheter placement. Patients in the simultaneous group had a higher rate of wound contamination but there was no difference in rates of SSI, 30-day PD catheter complication, or 30-day mortality compared with the nonsimultaneous group. There was no difference when overall simultaneous abdominal surgery or gastrointestinal surgery was evaluated. In our 1:1 adjusted analysis, there was a higher rate of PD catheter complication (11.3% vs. 2.8%, p=0.049) and SSI (31.0% vs. 4.2%, p<0.001) in the nonsimultaneous group. CONCLUSIONS Thirty-day PD catheter complication and SSI in patients who underwent simultaneous abdominal surgery at time of catheter placement were noninferior to outcomes in the nonsimultaneous. LEVEL OF EVIDENCE Level III, Treatment study, Retrospective comparative study.
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10
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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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11
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Ponce D, de Moraes TP, Pecoits-Filho R, Figueiredo AE, Barretti P. Peritonitis in Children on Chronic Peritoneal Dialysis: The Experience of a Large National Pediatric Cohort. Blood Purif 2017; 45:118-125. [PMID: 29241184 DOI: 10.1159/000484344] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We performed this study to evaluate the incidence, risk factors, microbiology, treatment, and outcome of peritonitis in pediatric Peritoneal dialysis (PD) patients at a nationwide prospective study. METHODOLOGY Patients younger than 18 years recruited in the BRAZPD II study from 2004 to 2011, who presented their first peritonitis episode, were included in the study. RESULTS We found 125 first episodes of peritonitis in 491 children PD patients (0.43 episodes/patient-year). Patients free of peritonitis episode constituted 75.6% in 1 year. Culture-negative episodes were very high (59.2%) and gram-positive (GP) bacteria were the most commonly found organisms (58.8%). First-generation cephalosporin was the initial choice to cover GP (40.5%) and aminoglycosides was the most prescribed antibiotics used for gram-negative agents (27.5%). Treatment failure was 26.4%. Technique failure (TF) occurred in 12.1% and peritonitis was the main cause (65.1%). Pseudomonas (p = 0.04) and negative cultures (p < 0.001) were identified as predictors of TF. CONCLUSION Peritonitis remains a common complication of PD in children and negative cultures and pseudomonas had a negative impact on TF.
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Affiliation(s)
- Daniela Ponce
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
| | | | | | - Ana Elizabeth Figueiredo
- Programa de Pós-Graduação em Medicina e Ciências da Saúde (Nefrologia), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Pasqual Barretti
- Department of Medicine, São Paulo State University (UNESP), Botucatu, Brazil
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Hypogammaglobulinemia in infants receiving chronic peritoneal dialysis. Pediatr Nephrol 2017; 32:503-509. [PMID: 27718085 DOI: 10.1007/s00467-016-3487-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 07/29/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Peritonitis is a severe complication of chronic peritoneal dialysis (CPD) in infants. Few studies have been conducted to evaluate the relationship between hypogammaglobulinemia and peritonitis risk, and the potential benefit of intravenous immunoglobulins (IVIG) therapy in infants receiving CPD. METHODS Patients aged 0-12 months at initiation of CPD between 1985 and 2012 were eligible for inclusion in this retrospective study. Data collected from the start of CPD up to 2 years post-dialysis initiation included patient demographics, dialysis characteristics, serum immunoglobulin (IgG) levels, IVIG administration history, infectious complications and outcomes. Cox regression analysis and linear mixed model analysis were used for statistical analysis. RESULTS Twenty-six consecutive patients were included in the study. Annualized peritonitis rates for infants aged 0-30 days (≤1-month age group; n = 16; 320.3 patient-months) and 31-365 days (>1-12-month age group; n = 10; 163.3 patient-months) at dialysis initiation were 0.27 (1 episode per 45.8 patient-months) and 0.15 (one episode per 81.7 patient-months), respectively. Seventy-six percent of the serum IgG levels were >1 standard deviation below the age-appropriate mean levels, and these did not differ in those who developed peritonitis versus those who did not (p = 0.39). Serum IgG levels were significantly lower in patients on CPD with oligoanuria than in non-oliguric patients (p = 0.04) and in patients on CPD for >90 days as compared to those who had received CPD for <90 days (p = 0.018). IVIG therapy was provided to 20 patients with hypogammaglobulinemia; this high prevalence of IVIG usage precluded any drawing of conclusion on the potential role of IVIG in the prevention of peritonitis. CONCLUSIONS Hypogammaglobulinemia is a frequent complication of CPD during infancy. In our experience, it was not associated with an increased risk for peritonitis.
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Mizuno M, Suzuki Y, Sakata F, Ito Y. Which clinical conditions are most suitable for induction of automated peritoneal dialysis? RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0057-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Dotis J, Myserlis P, Printza N, Stabouli S, Gkogka C, Pavlaki A, Papachristou F. Peritonitis in children with automated peritoneal dialysis: a single-center study of a 10-year experience. Ren Fail 2016; 38:1031-5. [PMID: 27185324 DOI: 10.1080/0886022x.2016.1183256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Peritoneal dialysis (PD) constitutes the preferred dialysis modality for children requiring renal replacement therapy with peritonitis being one of the most common complications of PD. This study was performed to evaluate the epidemiology, microbiology, and outcomes of PD-associated peritonitis in Greek children for a 10-year period. A total of 27 patients (16 males) with a mean age 121.8 ± 57.2 months were retrospective analyzed. Patients were on PD therapy for a mean duration of 45.2 ± 26.1 months. We found 23 episodes of PD-associated peritonitis occurred in 9 out of 27 patients (0.23 episodes/patient-year), with four patients experienced two or more peritonitis episodes. Gram-positive bacteria were responsible for 15 (65.2%) peritonitis episodes, with Staphylococcus aureus being the predominant specie isolated in 30.4% of cases. A total of seven episodes of exit-site infections (ESIs) were identified in five patients (0.069 episodes/patient-year) with the most common bacteria isolated being S. aureus (57.4%). Initial antibiotic treatment included intraperitoneal vancomycin plus ceftazidime in the majority of cases (82.6%). At the end of study, 12 (44.4%) patients remained on PD, 11 (41.8%) underwent renal transplantation, 2 (7.4%) shifted to hemodialysis and unfortunately, two patients (7.4%) died. Conclusively, our study revealed a noticeable low peritonitis and ESIs rate as compared to international data and represents the first evaluation of the characteristics and outcomes of peritonitis in the Greek pediatric PD population.
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Affiliation(s)
- John Dotis
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Pavlos Myserlis
- b Medical School, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Nikoleta Printza
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Stella Stabouli
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Chrysa Gkogka
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Antigoni Pavlaki
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
| | - Fotios Papachristou
- a 1st Department of Pediatrics , Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki , Greece
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Jellouli M, Ferjani M, Abidi K, Hammi Y, Boutiba I, Naija O, Zarrouk C, Ben Abdallah T, Gargah T. [Peritonitis in pediatric patients receiving peritoneal dialysis]. Nephrol Ther 2015; 11:558-63. [PMID: 26520233 DOI: 10.1016/j.nephro.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. METHODS In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. RESULTS Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. CONCLUSION Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.
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Affiliation(s)
- Manel Jellouli
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie.
| | - Meriem Ferjani
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Kamel Abidi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Yosra Hammi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ilhem Boutiba
- Service de bactériologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ouns Naija
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Chokri Zarrouk
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de médecine interne et de néphrologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Tahar Gargah
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
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Kim JE, Park SJ, Oh JY, Kim JH, Lee JS, Kim PK, Shin JI. Noninfectious Complications of Peritoneal Dialysis in Korean Children: A 26-Year Single-Center Study. Yonsei Med J 2015; 56:1359-64. [PMID: 26256980 PMCID: PMC4541667 DOI: 10.3349/ymj.2015.56.5.1359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 10/13/2014] [Accepted: 10/23/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to investigate noninfectious complications of peritoneal dialysis (PD), including mechanical and metabolic complications, at a single center in Korea. MATERIALS AND METHODS We analyzed data from 60 PD patients aged ≤18 years (40 boys and 20 girls) during the period between 1986 and 2012. The collected data included gender, age, causes of PD, incidence of noninfectious complications, and treatment for the complications. RESULTS The mean duration of PD therapy was 28.7±42.1 months (range 1-240 months). The most common cause of end-stage renal disease was glomerular disease (43.3%). There were no statistically significant differences between patients with and without mechanical complications regarding gender, age at the start of PD, and total duration of PD. Outflow failure was the most common catheter-related complication (14.3%), followed by leakage (10.0%) and hernia (8.6%). Metabolic complications, such as hyperglycemia and hypokalemia, were observed in three of 16 patients. The frequency of noninfectious complications of PD in our study was comparable with those in previous pediatric studies. PD was switched to hemodialysis (HD) in only three patients. CONCLUSION Our results indicate that noninfectious complications of PD are common, though they hardly lead to catheter removal or HD in pediatric patients on PD.
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Affiliation(s)
- Ji Eun Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea
| | - Se Jin Park
- Department of Pediatrics, Ajou University School of Medicine, Daewoo General Hospital, Geoje, Korea
| | - Ji Young Oh
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea
| | - Ji Hong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Pyung Kil Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Il Shin
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, Korea
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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