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Factors associated with peritoneal dialysis catheter complications in children
Camille L Stewart1, Shannon N Acker1, Laura L Pyle2
1Department of Surgery, University of Colorado School of Medicine, 12631 E. 17th Ave., Aurora, CO 80045, USA.
Insights
Peritoneal dialysis (PD) catheter complications are common, increasing with dwell time. Lower weight children face higher leak risks, while early dialysis initiation may reduce PD catheter nonuse in acute kidney injury patients.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is a key renal replacement therapy for pediatric patients.
- PD catheter placement carries inherent risks, including potential nonuse.
Purpose of the Study:
- To identify factors associated with PD catheter complications in children.
- To investigate reasons for PD catheter nonuse in pediatric patients.
Main Methods:
- Retrospective chart review of 175 children with PD catheters (2000-2014).
- Logistic regression analysis to determine covariates linked to complications.
Main Results:
- 45.7% of children experienced 110 complications; increased dwell time correlated with higher complication rates.
- Children weighing <12.4 kg had significantly higher odds of PD catheter leaks (p=0.02).
- 12 children never used their PD catheters, primarily due to rapid recovery from acute kidney injury.
Conclusions:
- PD catheter complications are frequent and escalate with prolonged use.
- Lower body weight is a risk factor for PD catheter leaks; smaller initial dialysate volumes may help.
- Permitting dialysis on placement day for acute kidney injury patients could improve PD catheter utilization.
Background/Purpose:
Peritoneal dialysis (PD) is a common method of renal replacement therapy for children. However, placement of PD catheters has risk, and some are never used.
Methods:
We conducted a retrospective chart review of children with a PD catheter placed between 2000 and 2014. Logistic regression analyses were used to identify covariates associated with complications.
Results:
We identified 175 children with PD catheters. 110 complications developed in 80 children (45.7%). Complications including unexpected return to the operating room and peritonitis increased as the length of time a catheter was in place increased. Children who weighed <12.4 kg had 3.2 times greater odds of developing a leak (95% CI 1.21-8.63, p=0.02). Twelve children never used their PD catheters, 9 with acute kidney injury (AKI) who recovered from their disease more quickly than expected. No covariate was associated with nonuse.
Conclusions:
Complications with PD catheters are common and increase the longer catheters are in place. Lower weight children are at greater risk of PD catheter leak. Decreased initial volumes of dialysate in smaller children may mitigate this risk. Nonuse may be reduced if dialysis is permitted the day of placement for children with AKI.
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