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Peritoneal membrane failure in children on peritoneal dialysis
1Department of Pediatrics, University of Florida College of Medicine, Gainesville, USA.
Insights
Pediatric peritoneal dialysis (PD) patients rarely experience ultrafiltration (UF) failure. Unlike adults, children on PD typically develop type 2 UF due to atypical peritonitis, not time-dependent membrane issues.
Area of Science:
- Pediatric Nephrology
- Renal Replacement Therapy
- Peritoneal Dialysis
Background:
- Peritoneal dialysis (PD) is a crucial renal replacement therapy for children with end-stage renal disease.
- Ultrafiltration (UF) failure, a common complication in adult PD, is often linked to prolonged dialysis duration.
- Children typically undergo PD as a temporary measure before renal transplantation, often for shorter periods than adults.
Purpose of the Study:
- To investigate the causes of ultrafiltration failure in pediatric patients undergoing peritoneal dialysis.
- To determine if the incidence and types of UF failure in children differ from those reported in adult populations.
Main Methods:
- A retrospective chart review was conducted on 172 pediatric patients receiving chronic PD.
- Data collected included patient demographics, duration of PD treatment, and types of PD modalities used.
- Causes of ultrafiltration failure were identified, with a focus on peritonitis-related complications.
Main Results:
- Only 5.8% of pediatric patients developed ultrafiltration failure, specifically type 2 UF.
- Type 2 UF in children was primarily associated with atypical peritonitis caused by Candida albicans, Mycobacterium fortuitum, Achromatium spp., and Pseudomonas aeruginosa.
- No cases of type 1 or type 3 UF were identified, and time on dialysis did not significantly correlate with membrane failure in this cohort.
Conclusions:
- The etiology of peritoneal membrane failure in children undergoing PD differs significantly from adults.
- Atypical peritonitis is the main driver of UF failure in pediatric PD patients, rather than the time-dependent membrane changes seen in adults.
- These findings highlight the need for specific management strategies for UF complications in pediatric PD populations.
Abstract:
Peritoneal dialysis (PD) success depends on adequate renal function replacement. Reports in adult dialysis populations indicate the risk of ultrafiltration failure (UF) increases with the time on dialysis. Type 1 UF is the most common. For children, dialysis modalities are temporizing measures until renal transplantation, considered optimal therapy for end-stage renal disease in children, can be performed. Children are frequently on dialysis for less than 2 years prior to transplantation. Thus if type 1 UF frequency increases with time on dialysis, it would be expected to occur less frequently in children, because they often are on dialysis for shorter periods. A retrospective chart review was performed to determine the cause of ultrafiltration failure in children; 172 children, mean age 8.0 +/- 5.5 (SD) years received a mean of 15 +/- 11.9 (SD) months of chronic PD; 39 patients received only continuous ambulatory peritoneal dialysis, 18 received only continuous cycling peritoneal dialysis, 22 received only tidal PD, and 94 received more than one type of PD. Ten patients (5.8%) developed type 2 UF failure as sequellae of atypical peritonitis, Candida albicans (6 patients), Mycobacterium foruitum (2), Achromatium spp. (1), and Pseudomonas aeruginosa (1). There was no significant difference in time on dialysis for children who developed membrane failure. No patients with type 1 or type 3 UF could be identified. It appears that the causes of peritoneal membrane failure in children are different from those in adults.