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Peritonitis in continuous ambulatory peritoneal dialysis in children living in Saudi Arabia
1Department of Pediatrics, Riyadh Medical Complex, Saudi Arabia.
Insights
Peritonitis is common in children undergoing continuous ambulatory peritoneal dialysis (CAPD) in Saudi Arabia, often caused by Gram-negative bacteria. Recurrent peritonitis frequently leads to catheter replacement and potential peritoneal membrane loss.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Renal Replacement Therapy
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a vital treatment for pediatric end-stage renal disease.
- Peritonitis and catheter-related infections are significant complications in CAPD patients.
- Understanding the epidemiology and causative agents of peritonitis is crucial for effective management in children.
Purpose of the Study:
- To review the clinical features, incidence, and outcomes of peritonitis and catheter infections in children on CAPD in Saudi Arabia.
- To identify common pathogens and risk factors associated with peritonitis in this pediatric population.
- To assess the impact of peritonitis on treatment and patient outcomes, including catheter survival and peritoneal membrane integrity.
Main Methods:
- Retrospective review of clinical data from 64 children undergoing CAPD over a 6-year period.
- Analysis of peritonitis episodes, including time to first episode, incidence rates, and causative organisms.
- Evaluation of outcomes such as recurrent peritonitis, catheter replacement, peritoneal membrane loss, and mortality.
Main Results:
- Peritonitis occurred in 64% of children, with a mean time to the first episode of 7.2 months.
- The incidence of peritonitis was 1 episode per 9 treatment months.
- Gram-negative organisms (42%) were the most common cause, followed by Gram-positive (20%) and Candida albicans (6%); 32% were culture-negative.
- Recurrent peritonitis affected 20 cases, leading to catheter replacement in 44% of patients.
- Peritoneal membrane loss occurred in 7 patients, often linked to Candida or recurrent Pseudomonas peritonitis.
Conclusions:
- Peritonitis is a frequent complication in pediatric CAPD patients in Saudi Arabia, predominantly caused by Gram-negative bacteria.
- Recurrent peritonitis poses a significant risk for catheter loss and peritoneal membrane damage.
- Effective strategies are needed to prevent and manage peritonitis to improve long-term outcomes for children on CAPD.
Abstract:
The clinical aspects of peritonitis and catheter infections were reviewed in 64 children on continuous ambulatory peritoneal dialysis living in Saudi Arabia over a period of 6 years. Peritonitis occurred in 41 children (64%). The mean time from starting dialysis to the first episode of peritonitis was 7.2 months. The incidence of peritonitis was 1 episode in 9 treatment months. Gram-negative organisms were responsible for the majority of episodes (42%), followed by Gram-positive organisms (20%), and Candida albicans (6%); 32% were culture negative. Recurrent peritonitis was present in 20 cases. Catheter was replaced in 24 patients: 44% due to recurrent peritonitis. Peritoneal membrane loss occurred in 7 patients, 3 had Candida peritonitis and 3 had recurrent peritonitis due to Pseudomonas. The mortality rate was 4.6% but none of the deaths were related to peritonitis or dialysis.