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Decreased incidence of peritoneal dialysis-associated peritonitis in young children
Peong Gang Park1,2, Yo Han Ahn1,3,4, Hee Gyung Kang1,3,4
1Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.
Insights
The incidence of peritoneal dialysis-associated peritonitis decreased significantly in children over two decades. Younger children, previously at higher risk, now show no increased risk, improving outcomes for pediatric patients on peritoneal dialysis.
Area of Science:
- Pediatric Nephrology
- Dialysis Complications
- Infectious Disease Epidemiology
Background:
- Peritonitis is a frequent complication of peritoneal dialysis (PD).
- Understanding trends in PD-associated peritonitis is crucial for patient management.
- Investigating changes in incidence, risk factors, and outcomes is essential.
Purpose of the Study:
- To analyze temporal changes in PD-associated peritonitis incidence.
- To identify evolving risk factors for peritonitis in pediatric PD patients.
- To assess changes in microbiology and clinical outcomes over time.
Main Methods:
- Retrospective study of pediatric patients initiating chronic PD (2000-2017).
- Patients divided into two cohorts: 2000-2008 and 2009-2017.
- Comparison of peritonitis incidence, characteristics, and survival rates between cohorts.
Main Results:
- Peritonitis incidence decreased from 0.35 to 0.21 episodes/patient-year (P=0.001).
- Younger children (<2 years) had lower peritonitis-free survival (2000-2008, P=0.004).
- This age-related risk was not observed in the later cohort (2009-2017).
Conclusions:
- PD-associated peritonitis incidence has declined in pediatric patients.
- Younger age is no longer a significant risk factor for peritonitis in recent PD patients.
- Improved management strategies have likely reduced peritonitis risk in vulnerable pediatric populations.
Aim:
Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades.
Methods:
This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups.
Results:
A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period.
Conclusions:
The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.
