Outcome and Risk Factors for Mortality in Pediatric Peritoneal Dialysis

Tsai, Hsin Lin; Yang, Ling; Chin, Taiwai; Wang, Hsin-Hui; Liu, Chin Su; Wei, Chou Fu; Chang, Jei Wen

doi:10.3747/pdi.2008.00278

Cited by 24 publications

(17 citation statements)

References 44 publications

(44 reference statements)

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“…This is consistent with the results of other studies showing decreased catheter survival and an increased frequency of infectious complications in patients with any type of ostomy (20)(21)(22)(23). Advanced surgical planning for PD catheter and gastrostomy button/tube placement is extremely important, and discussions between surgery and nephrology team members should address the optimal timing of both procedures and the need for prophylactic antibiotic/antifungal therapy (24).…”

Section: Discussionsupporting

confidence: 82%

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Borzych-Dużałka¹,

Aki²,

Azócar³

et al. 2016

CJASN

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Background and objectives Little published information is available about access failure in children undergoing chronic peritoneal dialysis. Our objectives were to evaluate frequency, risk factors, interventions, and outcome of peritoneal dialysis access revision. Results In total, 452 access revisions were recorded in 321 (13%) of 2453 patients over 3134 patient-years of followup, resulting in an overall access revision rate of 0.14 per treatment year. Among 824 incident patients, 186 (22.6%) underwent 188 access revisions over 1066 patient-years, yielding an access revision rate of 0.17 per treatment year; 83% of access revisions in incident patients were reported within the first year of peritoneal dialysis treatment. Catheter survival rates in incident patients were 84%, 80%, 77%, and 73% at 12, 24, 36, and 48 months, respectively. By multivariate logistic regression analysis, risk of access revision was associated with younger age (odds ratio, 0.93; 95% confidence interval, 0.92 to 0.95; P,0.001), diagnosis of congenital anomalies of the kidney and urinary tract (odds ratio, 1.28; 95% confidence interval, 1.03 to 1.59; P=0.02), coexisting ostomies (odds ratio, 1.42; 95% confidence interval, 1.07 to 1.87; P=0.01), presence of swan neck tunnel with curled intraperitoneal portion (odds ratio, 1.30; 95% confidence interval, 1.04 to 1.63; P=0.02), and high gross national income (odds ratio, 1.10; 95% confidence interval, 1.02 to 1.19; P=0.01). Main reasons for access revisions included mechanical malfunction (60%), peritonitis (16%), exit site infection (12%), and leakage (6%). Need for access revision increased the risk of peritoneal dialysis technique failure or death (hazard ratio, 1.35; 95% confidence interval, 1.10 to 1.65; P=0.003). Access dysfunction due to mechanical causes doubled the risk of technique failure compared with infectious causes (hazard ratio, 1.95; 95% confidence interval, 1.20 to 2.30; P=0.03).Conclusions Peritoneal dialysis catheter revisions are common in pediatric patients on peritoneal dialysis and complicate provision of chronic peritoneal dialysis. Attention to potentially modifiable risk factors by pediatric nephrologists and pediatric surgeons should be encouraged.

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Section: Discussionsupporting

confidence: 82%

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Borzych-Dużałka¹,

Aki²,

Azócar³

et al. 2016

CJASN

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“…12,13 Nesta amostra a mortalidade global foi de 30%, embora, tal como descrito na literatura, 6,8,9,15,[19][20][21] se tenha notado uma melhoria desta tendência na última década do estudo e não se tenham registado óbitos de crianças com DRCT primária. A mortalidade em crianças que iniciam DP antes dos dois anos é até quatro vezes superior à encontrada em crianças mais velhas.…”

Section: Discussionunclassified

“…A mortalidade em crianças que iniciam DP antes dos dois anos é até quatro vezes superior à encontrada em crianças mais velhas. 6,8,9,15,[19][20][21] Em séries europeias e norte-americanas publicadas, a taxa de sobrevivência, após um ano em DP, em crianças com idade inferior a dois anos é de cerca de 85%, comparativamente com uma taxa de 95% em crianças que iniciaram DP com idade superior a dois anos. 3,5,6,8,22 No entanto, alguns estudos descrevem que em crianças em DP com idade inferior a dois anos sem comorbilidades associadas, a sobrevida é semelhante à das crianças mais velhas.…”

Section: Discussionunclassified

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Deuchande¹,

Mano

Novais³

et al. 2016

Acta Med Port

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Introduction:Peritoneal dialysis is the dialytic method of choice in chronic end-stage renal disease in children. This study main purpose was to characterize the long-term survival of a pediatric population who began peritoneal dialysis within the first two years of life. Material and Methods: A descriptive and retrospective study was performed in a portuguese nephrology and renal transplantation pediatric unit, between January 1991 and August 2014. End-stage renal disease etiology, mortality, comorbidities and complications of peritoneal dialysis and end-stage renal disease, growth and psychomotor development were evaluated. Results: Twenty children started peritoneal dialysis within the first two years of life. There were six deaths, but no deaths of children with primary chronic kidney disease were registered over the past decade. The 14 living children were characterized; 13 were males. Congenital abnormalities of the kidney and urinary tract were the leading etiology of chronic kidney disease (45%). The average age start of peritoneal dialysis was 6.1 months; six children started before 30 days of life. Peritonitis was the most frequent cause of hospitalization. Ten children were transplanted at an average age of 5.3 years. All of the children who are still in peritoneal dialysis have short stature, but nine of the transplanted have final height within the expected for their mid-parental height target range. Nine (64%) had some type of neurodevelopmental delay. Discussion: Peritoneal dialysis is a technique possible and feasible since birth, as evidenced in the study, as more than half of children successfully started it before 6 months of life. It allows long-term survival until the possibility of renal transplantation despite the associated morbidity, including peritonitis and complications of chronic renal disease. The ten transplanted children improved their growth, recovered from chronic anemia and improved dyslipidemia, compared with the period of dialysis. However, the average waiting time until the renal transplant was 5.3 years higher than other international centers. Conclusion: These data support the use of peritoneal dialysis from birth, but complications and the worst growth reflect the need to develop strategies to optimize care relating to nutrition, growth and development and to reduce pre-transplant time.

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“…En pacientes pediátricos en tratamiento con hemofiltración también se describe un GER similar a los controles sanos, tras ajustar por masa magra (61). En este grupo de pacientes la prevalencia de desnutrición proteico-calórica es mayor que en el resto (61), siendo la hipoalbuminemia un factor independiente de mortalidad (62,63).…”

Section: Enfermedad Renal Necesidades Energéticasunclassified

Nutrición parenteral en situaciones clínicas especiales

Martínez¹,

Giner

2017

Nutr Hosp

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RECIÉN NACIDO PREMATUROLa nutrición parenteral (NP) constituye un pilar fundamental en la nutrición del recién nacido (RN) prematuro, especialmente en el RN muy prematuro (< 32 semanas de gestación) y RN prematuro extremo (< 28 semanas de gestación) (1). En estos pacientes, la administración de una NP balanceada y precoz se considera de elección (2). Dos metaanálisis han demostrado que la NP precoz en el RN prematuro < 1.500 g es segura, sin aumentar el riesgo de efectos adversos (3,4), y ha mostrado beneficios en relación con un balance nitrogenado positivo (ver aporte proteico) y mayor ganancia ponderal respecto a controles, aunque no se ha observado mayor longitud o perímetro craneal al alta en el grupo de intervención (3). Cabe destacar que los ensayos clínicos analizados cuentan con pequeño tamaño muestral y son heterogéneos (3,4). NECESIDADES ENERGÉTICASLa evidencia sobre las necesidades energéticas del RN prematuro es muy escasa, pues desde una aproximación empírica es muy difícil desligar el efecto de la energía administrada del obtenido por el aporte proteico y resto de nutrientes. Por tanto, las recomendaciones energéticas del RN prematuro se basan en el método factorial, asumiendo que su composición corporal es similar a la del feto y que el crecimiento debería ser similar al que ocurre intraútero (5). Actualmente, se recomienda un aporte inicial de 60 kcal/kg/día, con aumento rápido y progresivo hasta las 90-100 kcal/kg/día en la primera semana (1). Posteriormente se irá incrementado en función del peso de RN (2,6), con el objetivo de conseguir un crecimiento lo más próximo al crecimiento fetal (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" en las tablas II y III). MODIFICACIONES EN EL DISEÑO DEL PREPARADO DE NP Requerimientos proteicosEl aporte proteico mínimo para conseguir un balance nitrogenado positivo en el RN prematuro es 1,5 g/kg/día (6). No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas. Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).La fórmula de AA a administrar debe contener cisteína, tiro...

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Outcome and Risk Factors for Mortality in Pediatric Peritoneal Dialysis

Abstract: Mortality was low in our pediatric patients receiving CAPD. Hypoalbuminemia showed a significant association with death in CAPD patients.

Cited by 24 publications

References 44 publications

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Peritoneal Dialysis Access Revision in Children: Causes, Interventions, and Outcomes

Diálise Peritoneal nos Dois Primeiros Anos de Vida: Experiência de uma Unidade de Nefrologia e Transplantação Renal Pediátrica

Nutrición parenteral en situaciones clínicas especiales

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