Colostomy in children on chronic peritoneal dialysis

Chan, Eugene Yu-hin; Borzych-Dużałka, Dagmara; Alparslan, Caner; Harvey, Elizabeth; Munárriz, Reyner Loza; Runowski, Dariusz; Vidal, Enrico; Coccia, Paula; Jankauskienė, Augustina; Principi, Iliana; Serdaroğlu, Erkin; Szczepańska, Maria; Tse, Yincent; Vázquez, Ana Eugenia; Weaver, Donald J.; Schaefer, Franz; Warady, Bradley A.

doi:10.1007/s00467-019-04372-x

Cited by 15 publications

(8 citation statements)

References 18 publications

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“…Our data confirmed that APD was the prevalent initial modality across all treatment eras and age groups. HD, on the other hand, was reserved for children who failed PD or had contraindications, such as children with concurrent anorectal malformation requiring multiple abdominal surgeries and colostomy placement, who are at risk of infection 18 . PD is advantageous in children given its compatibility with normal schooling, better preservation of residual renal function and it does not require a vascular access.…”

Section: Discussionmentioning

confidence: 99%

Demographics and long‐term outcomes of children with end‐stage kidney disease: A 20‐year territory‐wide study

Chan¹,

Yap

Wong

et al. 2021

Nephrology

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Aim To evaluate the demographics and long‐term patient outcomes of children with end‐stage kidney disease in Hong Kong. Methods We conducted a cohort study at the Paediatric Nephrology Centre, the designated site providing kidney replacement therapy (KRT) for children in Hong Kong. The clinical characteristics and outcomes of all children who initiated chronic KRT before 19 years, between 2001 and 2020, were analysed. Results One hundred forty‐seven children (50% male) received KRT at a mean age of 11.4 ± 5.7 years. The incidence of ESKD was 6.28 per million age‐related population (pmarp). The leading cause of ESKD was congenital anomalies (33%). Ten children (7%) had pre‐emptive kidney transplants, 104 (71%) and 33 (22%) patients received automated peritoneal dialysis and haemodialysis as initial KRT. The incidence of ESKD increased over time, and were 4.38, 5.07, 6.15 and 9.17 pmarp during 2001–2005, 2006–2010, 2011–2015 and 2016–2020, respectively (p = .005). Ninty‐seven patients (66%) received kidney transplants and the median time to receive a kidney graft was 3.7 years (95% CI 3.1–4.3). Only 10 patients had pre‐emptive kidney transplants. The mortality rate was 9.1 deaths per 1000‐patient‐years (95%CI 4.6–16.2). The survival probabilities at 1‐, 5‐, 10‐ and 15‐year were 100%, 94.8% (95%CI 90.7–98.9%), 89.7% (95% CI 83.4%–95.9%), 87.1% (95% CI 79.3%–94.9%), respectively. Standardised mortality ratio was 54.5. 72% of deaths were due to infections. Young infants and those without kidney transplants were associated with worse survival (p < .01). Multivariate analysis demonstrated that dialysis was the only factor associated with significantly increased risk of death (HRadj 12.9, 95% CI 2.7–63.2, p = .002). Conclusion We observed an increasing incidence of paediatric ESKD in Hong Kong with considerable waiting time to kidney transplant. Mortality risk is comparable to other developed countries and is highest among dialysis population. Efforts should be made to facilitate early access to paediatric kidney transplantation in Hong Kong.

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Section: Discussionmentioning

confidence: 99%

Demographics and long‐term outcomes of children with end‐stage kidney disease: A 20‐year territory‐wide study

Chan¹,

Yap

Wong

et al. 2021

Nephrology

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“…Performing PD catheter placement and colostomy formation in the same surgery is beneficial as the common left lower abdominal incision for the placement of a colostomy can also be used to perform omentectomy as well as PD catheter placement under direct vision and in the right position. Multiple-layer closure is used for the wounds, and, if possible, it is recommended to wait a few days before the first session of dialysis [5].…”

Section: Arm and Colostomy Management With Pdmentioning

confidence: 99%

“…However, although PD is the most preferred treatment for ESRD in infants, the presence of a colostomy increases the probability of developing PD-related complications [5]. Conventionally, PD was not initiated in patients with a colostomy due to the increased risk of peritonitis and catheter contamination.…”

Section: Arm and Colostomy Management With Pdmentioning

confidence: 99%

“…These complications lead to poor drainage of the dialysis fluid, which impacts the overall efficiency of dialysis. The International Pediatric Peritoneal Dialysis Network's current recommendation is for the PD catheter to exit on the side opposite from the colostomy site [5]. This can be optimized with laparoscopic placement, allowing visual guidance in directing the catheter away from any already-formed adhesions.…”

Section: Arm and Colostomy Management With Pdmentioning

confidence: 99%

“…In small children with ESRD, peritoneal dialysis (PD) is the preferred choice as it facilitates nutrition and fluid management and is often better tolerated than hemodialysis (HD). However, PD catheter placement in a peritoneum that is already breached by a colostomy enhances the probability of complications, including catheter-associated infections [3,5]. Thoughtful, expeditious, and complex measures are needed to avoid and manage complications in these newborns.…”

Section: Introductionmentioning

confidence: 99%

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Neonatal Renal Failure in the Setting of Anorectal Malformation: A Case Report and Literature Review

Svetanoff

Ahmed

Hendrickson

et al. 2021

Cureus

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Anorectal malformations (ARMs) can occur in isolation or in association with other anomalies, most commonly those of the genitourinary systems. Morbidity and mortality are highest among patients who develop end-stage renal disease (ESRD) either from severe congenital anomalies (dysplastic kidneys) or from repeated infections in those who have vesicoureteral reflux or persistent recto-urinary fistulas. We describe our management strategy for a patient born with an ARM and bilateral dysplastic kidneys to highlight the nuances and complex decision-making considerations required in taking care of this complex patient population.Our patient is a male twin born at 32 weeks' gestational age who was found to have bilateral dysplastic kidneys on prenatal ultrasound. On initial examination, an imperforate anus was identified along with a severe urethral stricture. Full workup also revealed sacral dysgenesis and confirmation of the dysplastic kidneys. On day of life 3, a laparoscopic diverting sigmoid colostomy was performed; urologic evaluation confirmed the severe urethral stricture, which required dilation to place an 8F council tip catheter. Due to his small size, peritoneal dialysis could not be initiated until five weeks of age. As full volumes could not be reached with peritoneal dialysis, he was soon transitioned to continuous renal replacement therapy.At five months of age, a laparoscopic-assisted posterior sagittal anorectoplasty (PSARP) was performed. As his urethral stricture had worsened, a suprapubic catheter had been placed for bladder decompression. Reversal of his colostomy was performed 15 days after PSARP. Unfortunately, the patient required three further surgical interventions due to abdominal wall and inguinal hernias contributing to filling and emptying dysfunction when utilizing peritoneal dialysis. He is currently 16 months of age and remains inpatient due to intermittent hemodialysis requirements along with autocycling of his peritoneal dialysis. He is working on developmental milestones, can pull to a stand, and is currently being evaluated for kidney transplantation.The development of ESRD in a neonate or infant with an ARM is rare and can be due to congenital dysplasia or agenesis of bilateral kidneys. While peritoneal dialysis is the preferred approach, catheter dysfunction can result from intra-abdominal adhesions or inadequate fluid removal from inguinal or abdominal wall hernias that form in the setting of increased intra-abdominal pressure required for peritoneal dialysis. Close collaboration is required between pediatric surgeons, nephrologists, and urologists to facilitate colonic and urologic reconstruction and manage catheter-related complications.

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