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Complications of gastrostomy feeding in children receiving peritoneal dialysis
I J Ramage1, E Harvey, D F Geary
1Hospital for Sick Children, Department of Pediatrics, University of Toronto, Ontario, Canada.
Insights
Gastrostomy tube (g-tube) feeding can improve nutrition in children with end-stage renal disease on peritoneal dialysis (PD). While complications exist, g-tube use is not contraindicated for these patients.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Surgical Nutrition
Background:
- Gastrostomy tube (g-tube) feeding enhances nutritional support for pediatric patients with end-stage renal disease.
- Peritoneal dialysis (PD) is a common renal replacement therapy in children.
Purpose of the Study:
- To assess the complications associated with g-tube feeding in children undergoing PD.
- To evaluate the impact of g-tube insertion on PD-related infectious complications.
Main Methods:
- Retrospective study comparing patients on PD with and without g-tube feeding.
- Analysis of patient-months to determine rates of peritonitis, exit site infections, and catheter replacement.
- Review of g-tube related complications including infections and bleeding.
Main Results:
- Patients with g-tubes on PD experienced more frequent peritonitis (7.8 vs 18.4 patient-months) and PD catheter replacement (39.9 vs 109.4 patient-months) compared to controls.
- G-tube insertion was associated with an increase in PD catheter exit site infections (PDESI) and PD catheter replacement.
- Thirty-four g-tube exit site infections and 37 g-tube replacements occurred; 10 concurrent infections involved the same organism.
- Three cases of significant gastrointestinal bleeding were noted, one fatal.
Conclusions:
- G-tube feeding in pediatric PD patients is associated with an increased risk of infectious complications and g-tube related issues.
- Despite potential risks, g-tube feeding is not contraindicated in children with end-stage renal disease receiving PD.
- Careful monitoring and management are essential for patients utilizing both PD and g-tube feeding.
Abstract:
Gastrostomy tube (g-tube) feeding is recognized to improve the nutritional delivery to children with end-stage renal disease. A retrospective study was undertaken assessing the complications of g-tube feeding in children receiving peritoneal dialysis (PD). Twenty-three patients, mean age 3.8+/-3.2 years received PD and g-tube feeding for 758 patient-months, with 127 patients receiving PD for 1,969 patient-months used as controls. Peritonitis occurred every 18.4 patient-months in controls and 7.8 patient-months in those with a g-tube. Peritonitis occurred every 6.0 patient-months before and 8.1 patient-months after g-tube insertion in those undergoing g-tube insertion on PD. PD catheter exit site infection (PDESI) occurred every 18.7 patient-months in controls and 16.8 patient-months in those with a g-tube. PDESI occurred every 126 patient-months before and 16.2 patient-months following g-tube insertion. PD catheter replacement secondary to infection occurred every 109.4 patient-months in controls and 39.9 patient-months in those with a g-tube. It did not occur before g-tube insertion and occurred every 32.5 patient-months following insertion. Thirty-four episodes of g-tube exit site infection occurred, in 10 the same organism caused concurrent peritonitis. G-tube replacement occurred on 37 occasions. Hemodynamically significant gastrointestinal bleeding occurred in 3 patients, being terminal in 1. We conclude that, although not without risk, g-tube feeding in patients receiving PD is not contraindicated.