Peritonitis during continuous ambulatory peritoneal dialysis in children

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.