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Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis

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Abstract

Background

Many recommendations regarding peritonitis prevention in international consensus guidelines are opinion-based rather than evidence-based. The aim of this study was to examine the impact of peritoneal dialysis (PD) catheter insertion technique, timing of gastrostomy placement, and use of prophylactic antibiotics prior to dental, gastrointestinal, and genitourinary procedures on the risk of peritonitis in pediatric patients on PD.

Methods

We conducted a retrospective cohort study of pediatric patients on maintenance PD using data from the SCOPE collaborative from 2011 to 2022. Data pertaining to laparoscopic PD catheter insertion (vs. open), gastrostomy placement after PD catheter insertion (vs. before/concurrent), and no prophylactic antibiotics (vs. yes) were obtained. Multivariable generalized linear mixed modeling was used to assess the relationship between each exposure and occurrence of peritonitis.

Results

There was no significant association between PD catheter insertion technique and development of peritonitis (aOR = 2.50, 95% CI 0.64–9.80, p = 0.19). Patients who had a gastrostomy placed after PD catheter insertion had higher rates of peritonitis, but the difference was not statistically significant (aOR = 3.19, 95% CI 0.90–11.28, p = 0.07). Most patients received prophylactic antibiotics prior to procedures, but there was no significant association between prophylactic antibiotic use and peritonitis (aOR = 1.74, 95% CI 0.23–13.11, p = 0.59).

Conclusions

PD catheter insertion technique does not appear to have a significant impact on peritonitis risk. Timing of gastrostomy placement may have some impact on peritonitis risk. Further study must be done to clarify the effect of prophylactic antibiotics on peritonitis risk.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to SCOPE data use agreements but are available from the corresponding author on reasonable request.

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Acknowledgements

Participating centers that contributed data to the SCOPE Collaborative:

Children’s of Alabama, Phoenix Children’s Hospital, Arkansas Children’s Hospital, Children’s Hospital Los Angeles, Lucile Packard Children’s Hospital Stanford, UCLA Mattel Children’s Hospital, UCSF Benioff Children’s Hospital San Francisco, University of California Davis Children’s Hospital, Children’s Hospital Colorado, Connecticut Children’s Medical Center, Yale-New Haven Children’s Hospital, Nemours/Alfred I. duPont Hospital for Children, Children’s National Hospital , Arnold Palmer Hospital for Children, Nicklaus Children’s Hospital, Children’s Healthcare of Atlanta, Ann & Robert H. Lurie Children’s Hospital of Chicago, University of Iowa Stead Family Children’s Hospital, Children’s Hospital of New Orleans, Johns Hopkins Children’s Center, Boston Children’s Hospital, C.S. Mott Children’s Hospital, Helen DeVos Children’s Hospital, Masonic Children’s Hospital—University of Minnesota, Children’s Mercy Kansas City, SSM Health Cardinal Glennon Children’s Hospital, St. Louis Children’s Hospital, Children’s Hospital & Medical Center, Cohen Children’s Medical Center, Golisano Children’s Hospital at The University of Rochester Medical Center, New York-Presbyterian Morgan Stanley Children’s Hospital, The Children’s Hospital at Montefiore, The Mount Sinai Kravis Children’s Hospital, Upstate Golisano Children’s Hospital, Levine Children’s Hospital, Akron Children’s Hospital, Cincinnati Children’s Hospital Medical Center, Cleveland Clinic Children’s Hospital, Nationwide Children’s Hospital, UH Rainbow Babies & Children’s Hospital, Oklahoma Children’s Hospital, Doernbecher Children’s Hospital at Oregon Health & Science University, Children’s Hospital of Philadelphia, St. Christopher’s Hospital for Children, UPMC Children’s Hospital of Pittsburgh, MUSC Shawn Jenkins Children’s Hospital, Children’s Health Dallas, Cook Children’s Medical Center, Dell Children’s Medical Center of Central Texas, Driscoll Children’s Hospital, Texas Children’s Hospital, Primary Children’s Hospital, UVA Children’s Hospital, Seattle Children’s, American Family Children’s Hospital, Children’s Wisconsin

Author information

Authors and Affiliations

  1. Division of Pediatric Nephrology, SUNY Upstate Medical University, Physicians’ Office Building 805, 725 Irving Avenue, Syracuse, NY, 13210, USA

    Heather L. Wasik

  2. Division of Pediatric Nephrology, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA

    Mahima Keswani

  3. Division of Pediatric Nephrology, Seattle Children’s Hospital, Seattle, WA, USA

    Raj Munshi

  4. Division of Pediatric Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alicia Neu

  5. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson

  6. Division of Pediatric Nephrology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley Warady

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  1. Heather L. Wasik
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On Behalf Of the Standardizing Care to Improve Outcomes in Pediatric End-stage Kidney Disease (SCOPE) Investigators

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Correspondence to Heather L. Wasik.

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Wasik, H.L., Keswani, M., Munshi, R. et al. Assessment of potential peritonitis risk factors in pediatric patients receiving maintenance peritoneal dialysis. Pediatr Nephrol 38, 4119–4125 (2023). https://doi.org/10.1007/s00467-023-06076-9

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