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Non-infectious complications of peritoneal dialysis in children
Mattia Parolin1, Giovanni Ceschia1, Nicola Bertazza Partigiani1
1Department of Medicine (DMED), University of Udine, Udine, Italy.
Insights
Peritoneal dialysis (PD) is vital for children with stage 5 chronic kidney disease. While infections are reduced, non-infectious complications like catheter issues and membrane failure require ongoing management for effective treatment.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Renal Replacement Therapy
Background:
- Peritoneal dialysis (PD) is a primary treatment for pediatric end-stage renal disease.
- Advances in PD protocols have decreased infectious complications like peritonitis.
- Non-infectious complications remain a significant challenge to long-term PD efficacy in children.
Purpose of the Study:
- To review the current landscape of complications associated with peritoneal dialysis in pediatric patients.
- To highlight the persistent challenges posed by non-infectious complications.
- To emphasize the need for improved management strategies to optimize PD outcomes in children.
Main Methods:
- Review of current literature on pediatric peritoneal dialysis complications.
- Analysis of common and severe non-infectious complications.
- Discussion of strategies for complication mitigation and future research directions.
Main Results:
- Infectious complications, particularly peritonitis, have significantly decreased due to improved protocols.
- Mechanical issues (catheter dysfunction) and peritoneal membrane failure are prevalent non-infectious complications.
- Severe complications like encapsulating peritoneal sclerosis (EPS), metabolic disturbances, and hemoperitoneum also occur, necessitating careful monitoring.
Conclusions:
- Despite advances, non-infectious complications significantly impact the long-term success of PD in children.
- Effective management requires addressing mechanical issues, preserving peritoneal membrane integrity, and monitoring for rare but severe conditions like EPS.
- Future efforts should focus on optimizing catheter care, developing novel dialysis solutions, and enhancing patient monitoring to improve outcomes.
Abstract:
Peritoneal dialysis (PD) remains a cornerstone treatment for children with stage 5 chronic kidney disease, offering significant benefits in terms of quality of life and patient autonomy compared to hemodialysis. Recent advances in care protocols, particularly in infection prevention, have led to a substantial reduction in peritonitis and other infectious complications in pediatric patients on PD. Despite these improvements, non-infectious complications continue to pose significant challenges to the long-term efficacy of PD. Mechanical issues, such as catheter malposition and dysfunction, are common and can lead to discomfort and diminished dialysis efficiency. A more serious concern is peritoneal membrane failure, which results from prolonged PD, particularly with glucose-based solutions, and recurrent peritonitis, leading to structural changes in the membrane. Encapsulating peritoneal sclerosis (EPS), although rare, is a severe and often devastating complication that significantly impacts patient morbidity and mortality. Despite its low incidence, EPS underscores the importance of careful monitoring and management of long-term PD patients. Additional complications, including metabolic disturbances, pancreatitis, and hemoperitoneum, further complicate care. Looking ahead, improving catheter management, preserving peritoneal membrane function, and exploring new dialysis solutions are essential to reducing these complications and optimizing outcomes for pediatric patients on PD.
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