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Risk factors for early dialysate leakage around the exit site after catheter placement in pediatric peritoneal
Taishi Nada1,2, Koichi Kamei3, Mai Sato1
1Division of Nephrology and Rheumatology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
Insights
A longer break-in period for peritoneal dialysis (PD) catheters, ideally 14 days, can prevent dialysate leakage in children. Low body weight and single-cuffed catheters are significant risk factors for leakage in pediatric PD patients.
Area of Science:
- Pediatric Nephrology
- Dialysis Technology
Background:
- Dialysate leakage is a significant complication of peritoneal dialysis (PD), often leading to treatment discontinuation.
- Limited data exists on risk factors and optimal break-in periods for preventing leakage in pediatric PD patients.
Purpose of the Study:
- To identify risk factors for early dialysate leakage after Tenckhoff catheter placement in pediatric patients.
- To determine the appropriate break-in period for PD catheters in children to minimize leakage.
Main Methods:
- Retrospective study of pediatric patients (<20 years) undergoing Tenckhoff catheter placement.
- Comparison of clinical factors between patients with and without leakage within 30 days of catheter insertion.
Main Results:
- Dialysate leakage occurred in 7.8% of PD catheters (8/102).
- All leaks happened with break-in periods less than 14 days.
- Risk factors included low body weight, single-cuffed catheters, break-in periods ≤7 days, and long daily PD treatment time.
Conclusions:
- A break-in period exceeding 7 days, preferably 14 days, is recommended to prevent leakage in pediatric PD.
- Infants with low body weight are at high risk, and leakage prevention is challenging due to catheter insertion difficulties and potential complications.
Background:
Dialysate leakage, a major complication in peritoneal dialysis (PD), causes difficulty in continuing PD. However, literature evaluating risk factors for leakage in detail and the appropriate break-in period to avoid leakage in pediatric patients is scarce.
Methods:
We conducted a retrospective study on children aged < 20 years who underwent Tenckhoff catheter placement between April 1, 2002, and December 31, 2021, at our institution. We compared clinical factors between patients with and without leakage within 30 days of catheter insertion.
Results:
Dialysate leakage occurred in 8 of 102 (7.8%) PD catheters placed in 78 patients. All leaks occurred in children with a break-in period of < 14 days. Leaks were significantly more frequent in patients with low body weight at the catheter insertion, single-cuffed catheter insertion, a break-in period ≤ 7 days, and a long PD treatment time per day. Only one patient who had leakage with a break-in period > 7 days was neonate. PD was suspended in four of the eight patients with leakage and continued in the others. Two of the latter had secondary peritonitis, one of whom required catheter removal, and leakage improved in the remaining patients. Three infants had serious complications from bridge hemodialysis.
Conclusions:
A break-in period of > 7 days and if possible 14 days is recommended to avoid leakage in pediatric patients. Whereas infants with low body weight are at high risk of leakage, their difficulty in inserting double-cuffed catheter, hemodialysis complications, and possible leakage even under long break-in period make prevention of leakage challenging.
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