Catheter-related complications in children on chronic peritoneal dialysis.

Catheter-related complications--including infection, dialysate leak, subcutaneous leak, outflowfailure, and malfunction--are the principal causes of peritoneal dialysis (PD) failure. In the present retrospective study, we evaluated the catheter-related complications that occurred in children at our facility who were started on chronic PD during the period from July 1997 to August 2004. During the study period, 72 catheters were placed in 53 patients (28 girls, 25 boys). The average follow-up period was 29.4 + 19.3 months. Catheter-related complications developed in 41 patients. The risk for subcutaneous dialysate leak was no more significant when PD catheters were used early (< or = 7 days post placement) than when use was delayed (>7 days). Similarly, no significant difference was observed in the infection rate between the early- and delayed-use groups. During the study, 87 episodes of peritonitis occurred in 39 patients (1 episode / 18 patient-months). The infection rate was significantly different (p < 0.05) in patients with a low serum albumin level. No significant difference was seen between the early--and delayed--use groups in dialysis duration or number of catheter changes. However, we did observe a significant difference (p < 0.05) in subcutaneous leaks with longer dialysis duration. No correlation was observed between early or delayed catheter use and infection, dialysate leak, hernia, or subcutaneous leak. In conclusion, we observed no significant differences in catheter-related complications between early- and delayed-use catheter groups. A low serum albumin level appears to be a risk factor for infection after PD catheter placement.

Outcome in children on chronic peritoneal dialysis.

In this retrospective study, we evaluated the causative factors, outcomes, and complications of therapy in 35 patients (16 girls, 19 boys) started on chronic peritoneal dialysis (CPD) between 1997 and 2002. Average age at initiation of CPD was 9.3 +/- 4.4 years. All patients started on continuous ambulatory peritoneal dialysis (CAPD). Nine patients switched to ambulatory peritoneal dialysis (APD) during the follow-up period. The most common cause leading to end-stage renal disease (ESRD) in the patients was reflux nephropathy (22.9%). The major complication during therapy was peritonitis, with 41 episodes seen in 17 patients (1 episode per 18 patient-months). Of the children on APD, 7 developed 17 episodes of peritonitis (1 episode per 8.3 patient-months); of the children on CAPD, 10 developed 24 peritonitis attacks (1 episode per 24.9 patient-months). The other complications were inguinal hernia in 3 patients, subcutaneous leak in 4 patients, dialysate leak in 2 patients, pericardial effusion in 1 patient, umbilical hernia in 1 patient, hydrothorax in 1 patient, and cuff protrusion in 3 patients. During the follow-up period, 4 patients died owing to sepsis or cardiopulmonary complications. Only 1 patient was transferred to hemodialysis (owing to persistent Candida peritonitis). We think that CPD therapy is a good choice of treatment modality in the management of children with ESRD.