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Peritonitis in children on chronic peritoneal dialysis: analysis at 10 years
R Neiberger1, M H Aboushaar, M Tawan
1University of Florida, Gainesville.
Insights
In children undergoing peritoneal dialysis, 67% developed peritonitis, most commonly caused by gram-positive cocci. This study highlights the incidence and pathogens of peritonitis in pediatric patients on dialysis.
Area of Science:
- Nephrology
- Pediatric Dialysis
- Infectious Disease
Background:
- Peritoneal dialysis (PD) is a primary renal replacement therapy for pediatric patients awaiting kidney transplantation.
- Peritonitis represents a significant source of morbidity in children undergoing chronic PD.
Purpose of the Study:
- To retrospectively analyze pathogens, comorbid factors, and outcomes of peritonitis in children on PD.
- To establish the incidence and causative organisms of peritonitis in a pediatric PD population over a decade.
Main Methods:
- Retrospective review of pediatric patients (mean age 12.4 years) undergoing chronic PD from 1980-1989.
- Analysis of 219 episodes of peritonitis in 49 children, including pathogen identification from peritoneal fluid cultures.
- Calculation of peritonitis incidence and comparison with adult data.
Main Results:
- 67% of children (49/73) experienced peritonitis, with an incidence of one episode per 5.6 months.
- Gram-positive cocci were the predominant pathogens (73%), followed by gram-negative rods (22%).
- Peritoneal fluid cultures were positive in 77% of episodes; no deaths were attributed to peritonitis.
Conclusions:
- Peritonitis is a common complication in children on PD, with gram-positive cocci being the leading cause.
- The incidence of peritonitis in children on PD was higher than reported in adult populations.
- Despite high incidence, peritonitis in this cohort did not result in mortality.
Abstract:
Peritoneal dialysis is the major form of renal replacement therapy for children awaiting renal transplantation. Peritonitis is the major associated morbidity. We retrospectively identified the pathogens, co-morbid factors and outcome of peritonitis in children on peritoneal dialysis from 1980-1989. Seventy-three children, mean age 12.4 years, received 1,234 patient months of chronic peritoneal dialysis. Twenty-four patients (33%) remained peritonitis free until their dialysis catheters were removed after transplantation. Forty-nine children (67%) developed 219 episodes of peritonitis. Peritoneal fluid cultures were positive in 169 episodes (77%). Of the pathogens identified, 73% were gram positive cocci, 22% gram negative rods, 3% were fungus, and 2% other organisms. The incidence of peritonitis was one episode per 5.6 months. Over a 10 year period: 1) 67% of children on peritoneal dialysis developed peritonitis; 2) gram positive cocci accounted for most episodes; 3) the incidence in children was higher than that reported for adults; 4) there were no deaths attributable to peritonitis.