Factors influencing occurrence of peritonitis in Saudi children on peritoneal dialysis.

BACKGROUND: The peritonitis rate among children treated with peritoneal dialysis (PD) has not been widely reported in Saudi Arabia. The study aim was to estimate the peritonitis rate per patient-year and investigate the factors associated with higher peritonitis rates in a sample of PD children at King Abdullah Specialist Children's Hospital-Riyadh (KASCH-R), Saudi Arabia. METHODS: This retrospective cohort study included 27 PD children treated between September 2007 and December 2017 at KASCH-R. We recorded the children's demographic and clinical data, and the frequency of peritonitis. RESULTS: The 27 PD children reviewed (63% girls; mean age = 7.32 years old; range, 1-14 years), resulted in 86 peritonitis diagnoses in which the overall recurrence rate (in at least one episode) was 58/86 (67.4%) with a 95% confidence interval (CI), 56.5 to 77.2%. The rate of peritonitis episodes per patient-year was 0.76 (1 episode per 1.31 patient-year). The generalized Poisson model identified older children (age >  10 years) (adjusted rate ratios [aRR] = 7.273, 95% CI: 1.562-33.860), congenital nephrosis (aRR = 4.677, 95% CI: 1.443-15.155), height below 3rd percentile (aRR = 4.689, 95% CI: 1.874-11.735), weight below 3rd percentile (aRR = 5.388, 95% CI: 1.678-17.302), low albumin level (aRR = 4.041, 95% CI: 2.053-7.956), two-week duration of antibiotic therapy (aRR = 2.947, 95% CI: 1.163-7.468), which were independently associated with a high peritonitis rate. CONCLUSIONS: This study showed a high peritonitis rate in our center. Older children, congenital nephrosis, height and weight below the 3rd percentile, low albumin level, and long duration of antibiotic therapy were associated with a higher rate of peritonitis. An optimal peritonitis prevention strategy or best-practice guideline is needed to reduce and prevent peritonitis occurrence in our center.

Sleep-disordered breathing in children with chronic kidney disease.

BACKGROUND: The aim of our study was to ascertain the prevalence and type of sleep-disordered breathing (SDB) in paediatric patients with severe chronic kidney disease (CKD) based on the results of polysomnograms (PSGs). METHODS: Overnight PSGs were conducted on children with CKD stages 3-5 (dialysis dependent). Data were collected on patient demographics from the medical records. Study participants and/or their caregivers completed the paediatric modification of the Epworth Sleepiness Scale Score, the Pediatric Sleep Questionnaire (PSQ) and the Pediatric Quality of Life Inventory at the time of the PSG. RESULTS: Nineteen children were included in the study, of whom seven were on dialysis. The median (interquartile range) age at the time of the PSG was 13.5 (5.4-16.5) years, and eight (42%) of the children were male. There was a 37% (n = 7) prevalence of SDB in this cohort based on the PSG results. Central sleep apnea and obstructive sleep apnea were found in three children each. The PSQ scores did not correlate with the obstructive apnea-hypopnea index. CONCLUSIONS: There was a high prevalence of SDB in this cohort of children with CKD. The PSG and validated sleep questionnaires yielded discordant results, reinforcing the limitations of diagnosing SDB in the CKD population based solely on sleep questionnaires.