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Peritonitis in children being treated with continuous ambulatory peritoneal dialysis. CAPD Team
Y Y Chiou1, W P Chen, L Y Yang
1Department of Pediatrics, National Cheng Kung University Hospital, Tainan, R.O.C.
Insights
Peritonitis in pediatric continuous ambulatory peritoneal dialysis (CAPD) occurs every 15.2 patient-months, often caused by Staphylococcus. Technical aspects of dialysis, not nutrition, significantly impact peritonitis rates.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Dialysis Technology
Background:
- End-stage renal disease (ESRD) necessitates dialysis in pediatric patients.
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment option for pediatric ESRD.
- Peritonitis is a significant complication of CAPD.
Purpose of the Study:
- To determine the incidence of peritonitis in pediatric CAPD patients.
- To identify the causative agents and risk factors for peritonitis.
- To evaluate the impact of different disconnect systems on peritonitis rates.
Main Methods:
- Retrospective study of 24 pediatric CAPD patients over eight years.
- Analysis of peritonitis episodes, including incidence, microbiology, and clinical presentation.
- Comparison of peritonitis rates across various disconnect systems (manual spike, O-set, UV-XD, Y-set).
Main Results:
- Peritonitis incidence was one episode per 15.2 patient-months.
- Staphylococci species were the most common cause (76.4% culture-positive episodes).
- Cloudy dialysate (88%) was the primary symptom; manual spike systems showed higher peritonitis rates (1/4.6 patient-months) than others.
Conclusions:
- Technical aspects of the CAPD procedure are major contributors to peritonitis.
- Early identification and treatment are crucial, though hospitalization is often required.
- Disconnect system choice influences peritonitis risk in pediatric CAPD.
Abstract:
An eight-year retrospective study was performed to determine the incidence of peritonitis in a pediatric continuous ambulatory peritoneal dialysis (CAPD) population of 24 children, half of whom were boys and half, girls. All suffered from end stage renal disease (ESRD). When these children, aged 2 through 17 years (mean: 10.7 +/- 3.8), were examined, the incidence of peritonitis was one episode every 15.2 patient-months. Microbiologic evaluation showed that 76.4% of the 34 episodes were culture positive, with Staphylococci species (coagulase negative staphylococci 32.4%, Staphylococcus aureus 14.7%) causing most cases especially early in dialysis. Half the patients presented with a triad of symptoms (fever, abdominal pain and cloudy dialysate), with cloudy dialysate was the major presentation (88%). Peritonitis was treated with intraperitoneal administration of cefacin and/or netromycin when suspected, and 52.9% of the episodes needed hospitalization. Except for two patients who died of complications (sepsis, acute pancreatitis), all episodes of peritonitis were cured; in four episodes it was necessary to remove a catheter, and two of those cases came from fungal peritonitis. Peritonitis rates differed among disconnect systems. The manual spike had peritonitis rate of one episode per 4.6 patient-months which was higher than the O-set (one episode/22.2 patient-months), UV-XD and Y-set disconnect systems. Therefore, the major causes of peritonitis arose from contamination provoked by the technical aspect of the procedure. Nutrition status was stable in these patients. Serum albumin and total protein were adequate in all patients without relation to episode of peritonitis.(ABSTRACT TRUNCATED AT 250 WORDS)