Advertisement

Pediatric Nephrology

, Volume 20, Issue 10, pp 1478–1483 | Cite as

Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study

  • Michael Boehm
  • Andreas Vécsei
  • Christoph Aufricht
  • Thomas Mueller
  • Dagmar Csaicsich
  • Klaus Arbeiter
Original Article

Abstract

Recent US registry data and a European multicenter study described increased risk of peritonitis in young children on peritoneal dialysis (PD). No underlying age-specific risk factors could be defined in these reports. Therefore, we analyzed risk factors for peritonitis in children treated by PD as primary renal replacement therapy at the Kinderdialyse, Vienna, and particularly searched for age-specific aspects. Thirty children (15 boys, mean age 4.6 years) received PD [21 automated peritoneal dialysis (APD), nine continuous ambulatory peritoneal dialysis (CAPD)] for 13 months (3–49 months). During the total observation period of 395 dialysis months, 27 peritonitis episodes were diagnosed (1:14.6 months or 0.82/patient per year). Of our population, 43% remained peritonitis free; seven patients suffered from more than one peritonitis episode. Ten potential risk factors [age, gender, PD modality, duration of PD, exit-site status, urine volume, residual glomerular filtration rate (GFR), Kt/V, normalized protein catabolic rate (nPCR), albumin] and four indices of peritonitis outcome (peritonitis incidence, peritonitis burden, risk of suffering more than one episode of peritonitis and chance of staying free from peritonitis) were analyzed. Our study identified six risk factors in univariate analysis, namely age, APD treatment, exit-site infections, low urinary volume, low residual GFR and low nPCR, which were significantly correlated with two or more of the outcome indices. Multivariate analysis identified exit-site infection and residual urine volume as strong independent predictors. In summary, our study identified several age-dependent and age-independent risk factors for peritonitis in pediatric PD. These data demonstrate that the risk for peritonitis in small children is not pre-determined but might be open to therapeutic interventions, such as optimizing exit-site care, dialysis prescription and nutrition management.

Keywords

Peritonitis Risk factors APD exit-site infection Urine volume Residual GFR Kt/V nPCR 

References

  1. 1.
    Leonard MB, Donaldson LA, Ho M, Geary DF (2003) A prospective cohort study of incident maintenance dialysis in children: an NAPRTC study. Kidney Int 63:744–755CrossRefPubMedGoogle Scholar
  2. 2.
    Furth SL, Donaldson LA, Sullivan EK, Watkins SL (2000) Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatr Nephrol 15:179–182CrossRefPubMedGoogle Scholar
  3. 3.
    Ledermann SE, Scanes ME, Fernando ON, Duffy PG, Madden SJ, Trompeter RS (2000) Long-term outcome of peritoneal dialysis in infants. J Pediatr 136:24–29CrossRefPubMedGoogle Scholar
  4. 4.
    Wood EG, Hand M, Briscoe DM, Donaldson LA, Yiu V, Harley FL, Warady BA, Ellis EN (2001) Risk factors for mortality in infants and young children on dialysis. Am J Kidney Dis 37:573–579PubMedGoogle Scholar
  5. 5.
    Schaefer F, Klaus G, Muller-Wiefel DE, Mehls O (1999) Intermittent versus continuous intraperitoneal glycopeptide/ceftazidime treatment in children with peritoneal dialysis-associated peritonitis. The Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS). J Am Soc Nephrol 10:136–145PubMedGoogle Scholar
  6. 6.
    Mellits ED, Cheek DB (1970) The assessment of body water and fatness from infancy to adulthood. Monogr Soc Res Child Dev 35:12–26Google Scholar
  7. 7.
    Arbeiter K, Vecsei A, Mueller T, Sanz C, Balzar E, Aufricht C (2003) [Chronic peritoneal dialysis in children. Results of the Vienna Pediatric Dialysis Department]. Wien Klin Wochenschr 115:660–664PubMedGoogle Scholar
  8. 8.
    Kitzmuller E, Aufricht C, Murwald G, Muller T, Balzar E (1997) [Chronic peritoneal dialysis as home therapy in childhood—risks and complications]. Wien Klin Wochenschr 109:636–640PubMedGoogle Scholar
  9. 9.
    Seikaly M, Ho PL, Emmett L, Tejani A (2001) The 12th Annual Report of the North American Pediatric Renal Transplant Cooperative Study: renal transplantation from 1987 through 1998. Pediatr Transplant 5:215–231PubMedGoogle Scholar
  10. 10.
    Shroff R, Wright E, Ledermann S, Hutchinson C, Rees L (2003) Chronic hemodialysis in infants and children under 2 years of age. Pediatr Nephrol 18:378–383PubMedGoogle Scholar
  11. 11.
    Fine RN, Ho M (2002) The role of APD in the management of pediatric patients: a report of the North American Pediatric Renal Transplant Cooperative Study. Semin Dial 15:427–429CrossRefPubMedGoogle Scholar
  12. 12.
    Schaefer F, Klaus G, Mehls O (1999) Peritoneal transport properties and dialysis dose affect growth and nutritional status in children on chronic peritoneal dialysis. Mid-European Pediatric Peritoneal Dialysis Study Group. J Am Soc Nephrol 10:1786–1792PubMedGoogle Scholar
  13. 13.
    Szeto CC, Lai KN, Wong TY, Law MC, Leung CB, Yu AW, Li PK (1999) Independent effects of residual renal function and dialysis adequacy on nutritional status and patient outcome in continuous ambulatory peritoneal dialysis. Am J Kidney Dis 34:1056–1064PubMedGoogle Scholar
  14. 14.
    Warady BA (2001) Should the DOQI adequacy guidelines be used to standardize peritoneal dialysis in children? Perit Dial Int 21 [Suppl 3]:S174–S178Google Scholar
  15. 15.
    Strippoli G, Tong A, Johnson D, Schena F, Craig J (2004) Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database Syst Rev CD004679Google Scholar
  16. 16.
    Verrina E, Honda M, Warady BA, Piraino B (2000) Prevention of peritonitis in children on peritoneal dialysis. Perit Dial Int 20:625–630PubMedGoogle Scholar
  17. 17.
    Rinaldi S, Sera F, Verrina E, Edefonti A, Gianoglio B, Perfumo F, Sorino P, Zacchello G, Cutaia I, Lavoratti G, Leozappa G, Pecoraro C, Rizzoni G (2004) Chronic peritoneal dialysis catheters in children: a fifteen-year experience of the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Perit Dial Int 24:481–486PubMedGoogle Scholar
  18. 18.
    Mak SK, Wong PN, Lo KY, Tong GM, Fung LH, Wong AK (2000) Randomized prospective study of the effect of increased dialytic dose on nutritional and clinical outcome in continuous ambulatory peritoneal dialysis patients. Am J Kidney Dis 36:105–114PubMedGoogle Scholar
  19. 19.
    Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, Mujais S (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13:1307–1320PubMedGoogle Scholar
  20. 20.
    Holtta T, Ronnholm K, Jalanko H, Holmberg C (2000) Clinical outcome of pediatric patients on peritoneal dialysis under adequacy control. Pediatr Nephrol 14:889–897PubMedGoogle Scholar

Copyright information

© IPNA 2005

Authors and Affiliations

  • Michael Boehm
    • 1
  • Andreas Vécsei
    • 2
  • Christoph Aufricht
    • 1
  • Thomas Mueller
    • 1
  • Dagmar Csaicsich
    • 1
  • Klaus Arbeiter
    • 1
  1. 1.Department of PediatricsAKH WienViennaAustria
  2. 2.St. Anna KinderspitalViennaAustria

Personalised recommendations