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Does allograft failure impact infection risk on peritoneal dialysis: a North American Pediatric Renal Trials and
Ashton Chen1, Karen Martz, Panduranga S Rao
1Department of Pediatrics, Section of Pediatric Nephrology, Wake Forest Baptist Health, Winston-Salem, North Carolina 27157, USA. achen@wfubmc.edu
Insights
Pediatric patients on peritoneal dialysis (PD) after kidney transplant failure face a slightly higher risk of peritonitis. This study compared infection risk in children with prior allograft failure versus those new to PD.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Peritoneal Dialysis
Background:
- Adult studies indicate increased infection risk in patients returning to peritoneal dialysis (PD) after allograft failure.
- The effect of allograft failure on infection risk in pediatric PD patients remains unclear.
Purpose of the Study:
- To compare peritonitis-free survival in pediatric PD patients with and without a history of allograft failure.
- To assess the impact of prior allograft failure on infection risk in children undergoing PD.
Main Methods:
- A cohort of 2829 pediatric patients (ages 2-21) initiating PD between 1992-2007 was analyzed.
- Patients were categorized as transplant-naive or having prior allograft failure.
- Peritonitis-free survival was compared using Kaplan-Meier estimates and Cox regression analysis.
Main Results:
- 445 patients had prior allograft failure; 2384 were transplant-naive.
- Significant demographic differences existed between the groups.
- Poorer peritonitis-free survival was observed in the allograft failure group, with borderline significance after adjustment.
Conclusions:
- Children initiating PD after allograft failure may have a marginally increased risk of peritonitis.
- Further research may be needed to fully elucidate risk factors and management strategies.
Background And Objectives:
Several adult studies report that patients returning to peritoneal dialysis after allograft failure have increased infection-related morbidity. The impact of allograft failure on infection risk in children is uncertain. We compared peritonitis-free survival between pediatric peritoneal dialysis patients with prior allograft failure and those who were transplant naive.
Design, Setting, Participants, & Measurements:
We studied patients, 2-21 years of age, who initiated peritoneal dialysis from January 1, 1992, to December 31, 2007, in the North American Pediatric Renal Trials and Collaborative Studies registry. Demographic characteristics were compared between transplant naive and allograft failure patients using a chi-squared statistic. Peritonitis-free survival was compared between the two groups using Kaplan-Meier estimates. A Cox regression analysis was performed to adjust for covariates, which impact risk of peritonitis.
Results:
Of 2829 patients on peritoneal dialysis, 445 had a prior history of allograft failure and 2384 did not (transplant naive). Demographic characteristics including age at dialysis initiation, race, primary renal disease, and era of dialysis initiation were significantly different between the two groups. Peritonitis-free survival was poorer for the allograft failure group. After covariate adjustment, allograft failure showed borderline significance as a factor predictive of peritonitis.
Conclusions:
Children initiating peritoneal dialysis after allograft failure may experience a slightly higher infection risk.
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