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Peritonitis during continuous ambulatory peritoneal dialysis in children
Insights
Continuous ambulatory peritoneal dialysis (CAPD) is beneficial for children, but peritonitis is a common complication. Prompt antibiotic treatment is effective, and CAPD can still be successful despite peritonitis episodes.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Infectious Disease Management
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) offers a viable renal replacement therapy for pediatric patients.
- Peritonitis is a significant and frequent complication associated with CAPD in children, impacting treatment outcomes.
- Understanding the incidence and management of peritonitis is crucial for optimizing CAPD in pediatric populations.
Purpose of the Study:
- To review the incidence and characteristics of peritonitis in children undergoing CAPD.
- To evaluate the effectiveness of intraperitoneal antibiotic treatment for peritonitis in this cohort.
- To assess the long-term impact of peritonitis on the success of CAPD in pediatric patients.
Main Methods:
- Retrospective review of 55 children (mean age 9.6 years) treated with CAPD between 1978 and 1984.
- Analysis of peritonitis episodes, including frequency, causative organisms, and treatment regimens.
- Assessment of treatment outcomes, recurrence rates, and need for catheter replacement.
Main Results:
- 67 episodes of peritonitis occurred in 33 of 55 children (1 episode per 9.4 patient-months).
- Intraperitoneal antibiotic therapy (cephalothin for gram-positive, tobramycin for gram-negative) was successful in all cases.
- Seven patients experienced recurrent peritonitis, with five requiring catheter replacement due to chronic infections.
Conclusions:
- Peritonitis is a common complication of CAPD in children but is effectively managed with intraperitoneal antibiotics.
- Despite frequent peritonitis episodes, CAPD remains a successful treatment modality for pediatric end-stage renal disease.
- Careful monitoring and timely antibiotic intervention are essential to maintain CAPD success and prevent complications like catheter loss.
Abstract:
The use of continuous ambulatory peritoneal dialysis (CAPD) in children has proved beneficial. However, peritonitis remains the major complication. A review of the incidence of peritonitis in 55 children (mean age 9.6 years) who underwent CAPD between 1978 and 1984 showed that there were 67 episodes of peritonitis (1 per 9.4 patient-months) in 33 of the 55. Three patients accounted for 22 of the episodes. In all cases, treatment with antibiotics, given intraperitoneally, was successful. Cephalothin was routinely given for infections due to gram-positive organisms, tobramycin for infections due to gram-negative organisms. Peritonitis recurred in seven patients, of whom five had to have their catheters replaced because of associated chronic infections of the deep peritoneal cuff, the exit site or the catheter tunnel. Although peritonitis was a common complication of CAPD in this population, it did not affect the success of the technique.
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