Related Experiment Video
Updated: Apr 20, 2026
A Retrograde Implantation Approach for Peritoneal Dialysis Catheter Placement in Mice
Published on: July 20, 2022
Infectious outcomes following gastrostomy in children receiving peritoneal dialysis
Chanel Prestidge1, Jane Ronaldson, William Wong
1Department of Paediatric Nephrology, Starship Children's Hospital, Park Road, Private Bag 92024, Auckland, 1142, New Zealand, chanelp@adhb.govt.nz.
Insights
Gastrostomy tube (GT) insertion in children with end-stage kidney disease (ESKD) on peritoneal dialysis (PD) did not increase fungal peritonitis risk. Enteral feeding via GT is safe and recommended for growth in pediatric ESKD patients on PD.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Clinical Nutrition
Background:
- Early enteral feeding is crucial for pediatric end-stage kidney disease (ESKD) patients.
- Gastrostomy tube (GT) insertion in patients on peritoneal dialysis (PD) raises concerns about increased peritonitis, particularly fungal.
- This study evaluates peritonitis rates associated with GT insertion in children undergoing PD.
Purpose of the Study:
- To assess the incidence of peritonitis, especially fungal peritonitis, following gastrostomy tube (GT) insertion in pediatric end-stage kidney disease (ESKD) patients on peritoneal dialysis (PD).
- To evaluate the safety and efficacy of early enteral feeding via GT in children with ESKD on PD.
Main Methods:
- Retrospective, single-centre study of 17 New Zealand children with ESKD.
- Inclusion criteria: GT placement during PD or PD initiation within 72 hours of GT insertion.
- Data collected on peritonitis rates before and after GT placement.
Main Results:
- No cases of fungal peritonitis were observed in the study cohort.
- Two cases of early peritonitis with gastrointestinal organisms were identified.
- No statistically significant difference in bacterial peritonitis rates was found before (0.6 episodes/patient-year) and after (1.21 episodes/patient-year) GT placement.
Conclusions:
- Gastrostomy tube (GT) insertion concurrent with or following peritoneal dialysis (PD) initiation is safe in pediatric end-stage kidney disease (ESKD) patients.
- Fungal peritonitis was not encountered in this cohort, contrary to initial concerns.
- Prompt initiation of enteral feeding via GT is recommended for children with ESKD on PD experiencing insufficient dietary intake to maintain growth velocity.
Background:
Early institution of enteral feeding in paediatric end-stage kidney disease (ESKD) is recommended. For patients on peritoneal dialysis (PD) there is concern that gastrostomy tube (GT) insertion may be complicated by increased peritonitis, in particular fungal. Our unit favours early planned GT insertion, and for those with late presentation, there is prompt consideration of GT insertion following dialysis initiation. This study evaluates our rates of peritonitis with GT insertion following or concurrent with PD initiation.
Methods:
This was a retrospective, single-centre, cross-sectional study of of 17 New Zealand children with ESKD who received PD in the period 2000-2011. Inclusion criteria were GT placement while on PD or initiation of PD within 72 h of GT insertion.
Results:
There were no cases of fungal peritonitis among the 17 children; however, two cases of early peritonitis with organisms derived from the gastrointestinal tract were identified. No statistically significant difference was found between incident rates of bacterial peritonitis before GT placement (0.6 episodes per patient-year; 95% confidence interval (CI) 0.26-1.18) and post-GT placement (1.21 episodes per patient-year; 95% CI 0.69-1.97).
Conclusion:
Fungal peritonitis has never been encountered by out unit during its many years of experience in GT placement in patients without advanced malnutrition. When children on PD have insufficient dietary intake to maintain appropriate growth velocity, enteral feeding should be initiated promptly. A GT is considered to be safe for long-term use in selected patients.
Related Concept Videos
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:25Peritoneal Dialysis III: Nursing Management
01:28Esophageal Perforation-II: Clinical Manifestations and Management
Clinical Manifestations:
01:18Bacterial Gastroenteritis
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...