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Multicenter study of effects of pediatric peritoneal dialysis practices on bacterial peritonitis
Deepa H Chand1, Michael E Brier, C Frederic Strife
1Nephrology and Hypertension, Akron Children's Hospital, 1 Perkins Square, Akron, OH 44308, USA. dchand@chmca.org
Insights
Pediatric peritoneal dialysis (PD) patients experienced fewer peritonitis episodes over time. Improved peritonitis-free intervals in children on PD were linked to evolving practice patterns and fewer prior infections.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Infectious Disease
Background:
- Bacterial peritonitis is a significant complication in pediatric peritoneal dialysis (PD) patients.
- It can lead to serious outcomes including catheter loss, hospitalizations, and sepsis.
Purpose of the Study:
- To assess changes in the incidence of peritonitis among pediatric PD patients over time.
- To identify practice patterns influencing peritonitis rates.
Main Methods:
- Prospective study comparing two cohorts of pediatric PD patients (under 21 years) from ESRD Networks 9/10 in 1991 (n=70) and 2002 (n=82).
- Data collected via questionnaires on patient demographics, clinical characteristics, dialysis parameters, and peritonitis episodes.
- Analysis of peritonitis-free intervals and associated practice patterns.
Main Results:
- The 2002 cohort was younger, had more non-white patients, and experienced fewer peritonitis episodes compared to the 1991 cohort.
- Peritonitis-free interval improved from 10.8 months in 1991 to 17.3 months in 2002.
- Observed practice shifts included increased prophylactic antibiotics, omentectomy, and use of cycler machines with parent operators.
Conclusions:
- Pediatric PD patients demonstrated an improved peritonitis-free interval between 1991 and 2002.
- Changes in clinical practice patterns appear to be associated with this improvement.
- Fewer prior peritonitis events were statistically linked to the reduced peritonitis rate in the later cohort.
Abstract:
Bacterial peritonitis is a major cause of morbidity in pediatric peritoneal dialysis (PD) patients and can lead to catheter removal, hospitalizations, peritoneal membrane dysfunction, and sepsis. The goal of this prospective study was to determine whether the incidence of peritonitis had improved over time and what practice patterns influenced peritonitis. Two cohorts of PD patients within the End-stage Renal Disease (ESRD) Networks 9/10 and who were <21 years old were prospectively followed for 1 year in 1991 and 2002 and included 70 and 82 patients, respectively. A questionnaire was completed for each patient outlining demographic, clinical, and dialysis characteristics. A second questionnaire was completed for each peritonitis episode. The 2002 cohort was younger, included more nonwhites, and had fewer peritonitis episodes. A shift in practice patterns was evident, with more of the 2002 cohort receiving prophylactic antibiotics and omentectomy at catheter insertion and using cycler machines with a parent operator. Peritonitis-free interval was 10.8 months in 1991 and 17.3 months in 2002. The only variable statistically related to the lower rate of peritonitis in 2002 was fewer prior peritonitis events. The results show an improvement in peritonitis-free interval in studied patients on PD, which appears to be related to numerous changes in practice patterns.
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