Pediatric Nephrology

, Volume 25, Issue 9, pp 1739–1745 | Cite as

Epidemiology and outcomes of peritonitis in children on peritoneal dialysis in Australasia

  • Esmeralda B. Bordador
  • David W. Johnson
  • Paul Henning
  • Sean E. Kennedy
  • Stephen P. McDonald
  • John R. Burke
  • Steven J. McTaggart
  • On behalf of the Australian and New Zealand Dialysis and Transplant Registry
Original Article

Abstract

Peritonitis is a common complication and major cause of morbidity in children on peritoneal dialysis. In this retrospective longitudinal study, we analysed data retrieved from the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) on 167 patients aged less than 18 years of age who were treated with peritoneal dialysis during the period from October 2003 to December 2007. During this period there were 100 episodes of peritonitis in 57 patients (0.71 episodes/patient-year), with Gram-positive organisms most commonly isolated (44%). Peritonitis occurred frequently in the first 6 months after starting dialysis, with survival analysis showing peritonitis-free survival rates of 72%, 56% and 36% at 6 months, 1 year and 2 years respectively. Age was a weak predictor of peritonitis on univariate analysis, but previous peritonitis was the only significant predictor in a multivariate Cox proportional hazards model (adjusted hazard ratio 2.02; 95% CI: 1.20 to 3.40, p = 0.008). Peritonitis episodes infrequently resulted in relapse (5%), recurrence (7%) or the need for either temporary or permanent haemodialysis (5% and 7% respectively) and there were no patient deaths directly attributable to peritonitis. Compared with single organism peritonitis, polymicrobial peritonitis was not associated with any statistically significant differences in outcome. Further prospective studies are required to determine the most appropriate prophylactic measures and antibiotic regimens for use in pediatric patients.

Keywords

Pediatrics Peritoneal dialysis Peritonitis ANZDATA 

References

  1. 1.
    Schroder CH, Geary DF (2008) Dialysis modality choice and initiation in children. In: Geary DF, Schaefer F (eds) Comprehensive pediatric nephrology. Mosby, Philadelphia, pp 817–822CrossRefGoogle Scholar
  2. 2.
    Alexander SR, Schaefer FS (2004) Peritonitis. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds) Pediatric dialysis. Kluwer, Dordrecht, pp 35–46Google Scholar
  3. 3.
    Furth SL, Donaldson LA, Sullivan EK, Watkins SL, North American Pediatric Renal Transplant Cooperative Study (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
  4. 4.
    Kuizon B, Melocoton TL, Holloway M, Ingles S, He J, Fonkalsrud EW, Salusky IB (1995) Infectious and catheter-related complications in pediatric patients treated with peritoneal dialysis at a single institution. Pediatr Nephrol 9 [Suppl 1]:S12–S17CrossRefPubMedGoogle Scholar
  5. 5.
    Warady BA, Feneberg R, Verrina E, Flynn JT, Muller-Wiefel DE, Besbas N, Zurowska A, Aksu N, Fischbach M, Sojo E, Donmez O, Sever L, Sirin A, Alexander SR, Schaefer F, IPPR (2007) Peritonitis in children who receive long-term peritoneal dialysis: a prospective evaluation of therapeutic guidelines. J Am Soc Nephrol 18:2172–2179CrossRefPubMedGoogle Scholar
  6. 6.
    Zurowska A, Feneberg R, Warady BA, Zimmering M, Monteverde M, Testa S, Calyskan S, Drozdz D, Salusky I, Kemper MJ, Ekim M, Verrina E, Misselwitz J, Schaefer F (2008) Gram-negative peritonitis in children undergoing long-term peritoneal dialysis. Am J Kidney Dis 51:455–462CrossRefPubMedGoogle Scholar
  7. 7.
    Schaefer F, Feneberg R, Aksu N, Donmez O, Sadikoglu B, Alexander SR, Mir S, Ha IS, Fischbach M, Simkova E, Watson AR, Moller K, von Baum H, Warady BA (2007) Worldwide variation of dialysis-associated peritonitis in children. Kidney Int 72:1374–1379CrossRefPubMedGoogle Scholar
  8. 8.
    Orr NI, McDonald SP, McTaggart S, Henning P, Craig JC (2009) Frequency, etiology and treatment of childhood end-stage kidney disease in Australia and New Zealand. Pediatr Nephrol 24:1719–1726CrossRefPubMedGoogle Scholar
  9. 9.
    Boehm M, Vecsei A, Aufricht C, Mueller T, Csaicsich D, Arbeiter K (2005) Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study. Pediatr Nephrol 20:1478–1483CrossRefPubMedGoogle Scholar
  10. 10.
    Chiu MC, Tong PC, Lai WM, Lau SC (2008) Peritonitis and exit-site infection in pediatric automated peritoneal dialysis. Perit Dial Int 28 [Suppl 3]:S179–S182PubMedGoogle Scholar
  11. 11.
    Chua AN, Goldstein SL, Bell D, Brewer ED (2009) Topical mupirocin/sodium hypochlorite reduces peritonitis and exit-site infection rates in children. Clin J Am Soc Nephrol 4:1939–1943CrossRefPubMedGoogle Scholar
  12. 12.
    Lim WH, Johnson DW, McDonald SP (2005) Higher rate and earlier peritonitis in Aboriginal patients compared to non-Aboriginal patients with end-stage renal failure maintained on peritoneal dialysis in Australia: analysis of ANZDATA. Nephrology (Carlton) 10:192–197CrossRefGoogle Scholar
  13. 13.
    Warady BA, Schaefer FS (2004) Peritonitis. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds) Pediatric dialysis. Kluwer, DordrechtGoogle Scholar
  14. 14.
    Warady BA, Schaefer F, Holloway M, Alexander S, Kandert M, Piraino B, Salusky I, Tranaeus A, Divino J, Honda M, Mujais S, Verrina E, International Society for Peritoneal Dialysis Advisory Committee on Peritonitis Management in Pediatric Patients (2000) Consensus guidelines for the treatment of peritonitis in pediatric patients receiving peritoneal dialysis. Perit Dial Int 20:610–624PubMedGoogle Scholar
  15. 15.
    Żurowska A, Zagozdzon I, Bałasz I, Latoszyńska J, Szczepanska M, Ziolkowska H, Stefaniak E, Makulska J, Jander A, Drozdz D, Wiercinski R, Zajączkowska B, Socik B, Hanna K, Sitene G (2008) Peritonitis in 203 children treated with peritoneal dialysis in the years 2000–2003 in Poland. Adv Clin Exp Med 17:167–172Google Scholar

Copyright information

© IPNA 2010

Authors and Affiliations

  • Esmeralda B. Bordador
    • 1
  • David W. Johnson
    • 2
    • 3
  • Paul Henning
    • 4
  • Sean E. Kennedy
    • 5
  • Stephen P. McDonald
    • 6
    • 7
  • John R. Burke
    • 1
    • 2
  • Steven J. McTaggart
    • 1
    • 3
  • On behalf of the Australian and New Zealand Dialysis and Transplant Registry
  1. 1.Queensland Child and Adolescent Renal ServiceRoyal Children’s Hospital and Mater Children’s HospitalsHerston, BrisbaneAustralia
  2. 2.Department of NephrologyPrincess Alexandra HospitalBrisbaneAustralia
  3. 3.University of QueenslandBrisbaneAustralia
  4. 4.Department of NephrologyWomen’s and Children’s HospitalAdelaideAustralia
  5. 5.Department of NephrologySydney Children’s HospitalSydneyAustralia
  6. 6.Australia and New Zealand Dialysis and Transplant RegistryAdelaideAustralia
  7. 7.Department of Nephrology & Transplantation ServicesUniversity of Adelaide at the Queen Elizabeth HospitalAdelaideAustralia

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