Peritoneal dialysis catheter complications in neonates with kidney failure

Neonates with kidney failure require placement of a peritoneal dialysis catheter (PD-C) shortly after birth. PD-C malfunction and peritonitis, both common in this population, are associated with PD failure. The aim of this study was to describe our center's PD-C-related practices and outcomes in neonates with kidney failure.

We performed a retrospective chart review of neonates who required kidney replacement therapy (KRT) within the first 30 days of life from 01/2018-12/2023. We evaluated for PD-C duration, PD-C replacement or revision, and peritonitis.

Twenty-four neonates had PD-C placed for chronic dialysis at a median of 9.7 days and 3 kg. Peritoneal dialysis (PD) was initiated a median of 14 days after PD-C placement, at a median age of 26.5 days. During a median follow-up time of 26.2 months, there were 42 PD-Cs tracked. Initial PD-C lasted a median of 355 days (IQR 165-632, range 50-953). Reasons for removal of initial PD-C included mechanical complications (38%), kidney transplant (25%), and infection (21%). There were 44 episodes of peritonitis in 19 patients. Seventeen of these episodes (39%) occurred within four weeks of a surgical procedure, despite all patients but one receiving perioperative antibiotic prophylaxis for all surgical procedures. The overall rate of peritonitis was 0.34 per 100-catheter days.

PD-C complications are common in this highly complex population, despite mitigation attempts with perioperative antibiotics. Future work should focus on neonatal-specific recommendations for surgery timings and prophylaxis to reduce the risk of infection and PD failure in the neonatal kidney failure population.