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Area of Science:

  • Pediatric Nephrology
  • Renal Replacement Therapy
  • Infectious Disease Management

Background:

  • Peritoneal dialysis (PD) is the preferred dialysis method for pediatric patients.
  • Peritonitis is a serious complication of PD, with early-onset peritonitis (EP) potentially leading to worse outcomes.
  • Limited data exists on EP in children, defined as peritonitis within 60 days of catheter insertion.

Purpose of the Study:

  • To investigate the incidence and risk factors for early-onset peritonitis (EP) in pediatric patients undergoing peritoneal dialysis (PD).
  • To identify potentially modifiable factors associated with EP in this population.

Main Methods:

  • Analysis of PD catheter insertion practices and EP episodes from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative database.
  • Multivariable analysis to identify factors associated with EP.

Main Results:

  • 98 episodes of EP occurred among 1106 PD catheters.
  • Early PD catheter use was significantly associated with EP (P=0.001).
  • Factors associated with early PD catheter use included younger age (<1 year), first catheter placement, plastic adapter use, exit site sutures, and early dressing changes. Concurrent hemodialysis catheter placement was protective.

Conclusions:

  • 8.4% of pediatric PD catheters were associated with EP.
  • Early PD catheter use is a significant risk factor for EP in children.
  • Modifying the timing of PD catheter use may be a target for reducing EP rates in pediatric PD patients.