Peritoneal Dialysis Catheters: Review of Neonatal Patient Outcomes

Although peritoneal dialysis (PD) is preferred over hemodialysis in most children, there are limited data on neonates.

Single-institution retrospective chart review on all neonates (≤4 wk old) with PD catheter placement (January 1, 2015 - December 31, 2023). Patients with primary congenital heart disease were excluded. Demographic and clinical data were collected. Median and interquartile ranges presented for nonparametric data.

The 21 patients were mostly male (81%) with median gestational age of 36 (35-38) wk and birth weight of 2.91 (2.68-3.33) kg. PD catheter placement was at 6 (5-8) d of life and 3.34 (2.96-3.96) kg. Primary diagnoses were autosomal recessive polycystic kidney disease (n = 5, 24%), renal agenesis or dysgenesis (n = 9, 43%), obstructive uropathy (n = 4, 19%) or other (n = 3, 14%). Nine (43%) catheters were placed laparoscopically, 8 (38%) open, and 4 (19%) percutaneously. Five (24%) patients died before discharge. Of the 16 (76%) survivors, 11 (69%) had complications: leakage (n = 7, 44%) and/or peritonitis (n = 6, 38%). Of the seven who had leakage, 6 (86%) initiated PD catheter use within 72 h of placement and 3 (43%) ultimately required premature catheter removal. Of those whose first time of use was at least 72 h after placement, 1 (13%) developed leakage and none were removed. There was no difference in leakage rate among methods of placement. The timing to the first use was not associated with the incidence of peritonitis.

PD catheter placement is feasible and safe in the neonatal population, but postplacement complications are common with two-thirds of patients suffering from leakage and/or peritonitis. Despite this, survival is high, and replacements of catheters are uncommon.