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Colostomy in children on chronic peritoneal dialysis

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Abstract

Background

This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy.

Methods

Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites.

Results

Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0–2.2) and 2.8 (IQR 0.2–18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9–35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2–7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis.

Conclusion

Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.

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Authors and Affiliations

  1. Paediatric Nephrology Centre, Hong Kong Children’s Hospital, Hong Kong, Hong Kong

    Eugene Y. H. Chan

  2. Medical University of Gdansk, Gdansk, Poland

    Dagmara Borzych-Duzalka

  3. Tepecik Teaching and Research Hospital, Izmir, Turkey

    Caner Alparslan

  4. Hospital for Sick Children, University of Toronto, Toronto, Canada

    Elizabeth Harvey

  5. Cayetano Heredia Hospital, Lima, Peru

    Reyner Loza Munarriz

  6. Children’s Memorial Health Institute, Warsaw, Poland

    Dariusz Runowski

  7. University-Hospital of Padova, Padova, Italy

    Enrico Vidal

  8. Hospital Italiano Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina

    Paula A. Coccia

  9. Vilnius University, Institute of Clinical Medicine, Vilnius, Lithuania

    Augustina Jankauskiene

  10. Hospital Pediátrico Humberto J Notti Mendoza, Mendoza, Argentina

    Iliana Principi

  11. Dr. Behcet Children Research and Education Hospital, Izmir, Turkey

    Erkin Serdaroglu

  12. SMDZ, Medical University of Silesia, Katowice, Poland

    Maria Szczepanska

  13. Great North Children’s Hospital, Newcastle Upon Tyne, UK

    Yincent Tse

  14. Hospital Del Nino San Justo, Buenos Aires, Argentina

    Aida Vazquez

  15. Levine Children’s Hospital of Carolinas HealthCare System, Charlotte, NC, USA

    Donald J. Weaver

  16. Center for Children and Adolescent Medicine, Heidelberg, Germany

    Franz Schaefer

  17. Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

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  1. Eugene Y. H. Chan
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  2. Dagmara Borzych-Duzalka
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  7. Enrico Vidal
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  13. Yincent Tse
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  14. Aida Vazquez
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  15. Donald J. Weaver
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  16. Franz Schaefer
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  17. Bradley A. Warady
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on behalf of the International Pediatric Peritoneal Dialysis Network

Corresponding author

Correspondence to Eugene Y. H. Chan.

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Chan, E.Y.H., Borzych-Duzalka, D., Alparslan, C. et al. Colostomy in children on chronic peritoneal dialysis. Pediatr Nephrol 35, 119–126 (2020). https://doi.org/10.1007/s00467-019-04372-x

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  • DOI: https://doi.org/10.1007/s00467-019-04372-x

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