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Factors predisposing and contributing to peritonitis during chronic peritoneal dialysis in children: a ten-year
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Peritonitis is a common complication in children on peritoneal dialysis, often leading to treatment failure. Continuous cycling peritoneal dialysis (CCPD) showed a lower incidence than continuous ambulatory peritoneal dialysis (CAPD).
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Peritonitis is a significant complication in pediatric patients undergoing peritoneal dialysis (PD).
- Recurrent peritonitis frequently leads to the failure of PD as a treatment modality.
Purpose of the Study:
- To identify factors contributing to and predisposing to peritonitis in children on PD.
- To compare the incidence of peritonitis between continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD).
Main Methods:
- Retrospective analysis of 83 children treated with CAPD or CCPD between 1978 and 1988.
- Evaluation of potential risk factors including patient demographics, medical history, dialysis parameters, and hygiene techniques.
Main Results:
- Fifty patients experienced 171 episodes of peritonitis; 33 patients remained peritonitis-free.
- The incidence of peritonitis was lower with CCPD compared to CAPD.
- Potential risk factors included patient noncompliance, upper respiratory tract infections, skin infections, and dental treatment.
- Leukopenia and leukocytosis were not reliable indicators for peritonitis diagnosis.
- Low serum IgG and albumin levels were observed, but lacked predictive value for peritonitis.
Conclusions:
- Recurrent peritonitis is a major cause of peritoneal dialysis failure in children.
- CCPD may offer a lower risk of peritonitis compared to CAPD.
- While several factors were investigated, peritonitis occurrence appeared largely random, highlighting the need for meticulous patient management and monitoring.
Abstract:
Factors contributing and predisposing to peritonitis were studied retrospectively in 83 children treated with continuous ambulatory (CAPD) or continuous cycling peritoneal dialysis (CCPD) from 1978 to 1988. Recurrent peritonitis was the most frequent complication and the major reason for peritoneal dialysis failure. Fifty patients had 171 episodes of peritonitis during the ten years and 33 remained peritonitis-free. The duration of dialysis was significantly shorter in the peritonitis-free group. The incidence of peritonitis was lower with CCPD than with CAPD. Leucopenia was not a predisposing factor nor was blood leucocytosis helpful in diagnosing peritonitis. Serum IgG was low in 33% of patients with episodes of peritonitis, but there was no correlation or predictive value in this finding. The C3 component of complement was relatively lower than the C4 but both components was relatively lower than the C4 but both components were usually in the normal range. Serum albumin was low in all patients, but lower in those with peritonitis episodes. Age, sex, primary disease, diapers, pyelostomies, dialysis training, and living conditions were not significantly associated risk factors. Sterile dressings gave no benefit over the shower technique. Patient noncompliance, upper respiratory tract infection, skin infections, and dental treatment were potential risk factors. However, peritonitis seemed to be distributed randomly among the patients.