The surgeon's role in chronic peritoneal dialysis

Area of Science:

• Pediatric Nephrology
• Renal Replacement Therapy

Background:

• Hemodialysis is the primary treatment for pediatric end-stage renal disease (ESRD).
• Peritoneal dialysis (PD) serves as a secondary option, crucial for infants, patients lacking vascular access, or those unstable on hemodialysis.
• Advancements in PD technology are increasing its use over hemodialysis due to medical, psychological, and economic benefits.

Purpose of the Study:

• To evaluate the efficacy and complications of chronic peritoneal dialysis in pediatric patients.
• To develop guidelines for preventing and managing PD-related complications in children.

Main Methods:

• A retrospective analysis of 46 pediatric patients undergoing chronic peritoneal dialysis.
• Data collected included 593 catheter-months, 74 procedures, and 56 catheter implantations.
• Complications such as infection and mechanical catheter occlusion were documented and analyzed.

Main Results:

• Peritonitis occurred in 13 patients (56 episodes), with 50 episodes treated medically.
• Subcutaneous catheter infections occurred in 5 instances.
• Mechanical catheter occlusion affected 10 patients, requiring surgery in 9. Four patients were switched to hemodialysis, and 5 died.

Conclusions:

• Chronic peritoneal dialysis is a frequently used and effective modality for pediatric ESRD.
• Infection and mechanical occlusion are the primary complications requiring vigilant management.
• Established guidelines can aid surgeons in optimizing PD outcomes and minimizing adverse events in children.