Peritoneal Dialysis in a Patient with Neurogenic Bladder and Chronic Kidney Disease with Ventriculoperitoneal Shunt

Abstract

Long-term dialysis in children with multiple handicaps has become easier with the advent of continuous ambulatory peritoneal dialysis (PD). Due to the widespread use of PD and the long survival of patients with spina bifida, an increasing number of patients with spina bifida are on PD. The viability and safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) have been a matter of concern. Some authors consider the presence of a VPS a relative contraindication for PD, but more recent reports suggest that PD under close monitoring is not contraindicated. We report a 17-year-old girl born with meningomyelocele, hydrocephalus and neurogenic bladder who was maintained on VPS. She reached end-stage renal failure 17 years later and was put on PD based on family and patient preference. She had an uneventful course in the initial 9 months, but later developed fungal peritonitis which was successfully managed with catheter withdrawal and an intravenous antifungal agent (amphotercin 0.75 mg/kg). Simultaneous ventricle-aspirated cerebrospinal fluid was sterile. To our knowledge, this is the first report of fungal infection in such a patient. Although we share the view that PD is not an absolute contraindication in patients with a functioning VPS, its likely complications, especially infectious complications in developing countries, should be kept in mind before initiating PD in such patients.

Chronic Peritoneal Dialysis in Children with Special Needs or Social Disadvantage or Both: Contraindications are not Always Contraindications

“…Some authors consider that the presence of a ventriculoperitoneal shunt is a relative contraindication to PD because of the potential risks of shunt-induced peritoneal damage and of infection ascending through the shunt (11,19). Patients with a ventriculoperitoneal shunt on CPD present specific diagnostic challenges because of overlapping symptoms secondary to PD or to complications of the ventriculoperitoneal shunt (3). More recent reports suggest that PD under close monitoring is not contraindicated in children with ESRD regardless of the presence of ventriculoperitoneal shunt (3,10).…”

“…Patients with a ventriculoperitoneal shunt on CPD present specific diagnostic challenges because of overlapping symptoms secondary to PD or to complications of the ventriculoperitoneal shunt (3). More recent reports suggest that PD under close monitoring is not contraindicated in children with ESRD regardless of the presence of ventriculoperitoneal shunt (3,10). In our series, patient 9, with a ventriculoperitoneal shunt, has been maintained on CPD treatment for 18 months.…”

“…It is particularly useful in very small patients with lack of vascular access, contraindications for anticoagulation, cardiovascular instability, and lack of proximity to pediatric HD centers. Chronic PD is associated with better control of blood pressure, better correction of acidemia and fluid balance, better growth and rehabilitation, and more liberalized food and water intake (3-5).…”

Ventrículo peritoneal shunt and peritoneal dialysis: “A paradigm for the health team”. Report of 4 cases

“…En la edad pediátrica una de las principales patologías que lleva a ERC por vejiga neurogénica e infecciones urinarias a repetición, es la espina bífi-da, condición en la cual muchos pacientes tienen una DVP y aunque no hay una estadística clara del nú-mero de pacientes pediátricos con espina bífida, que llegan a la ERC con requerimiento de TRR, en el estudio de Bowman et al, observaron que el 75% de los pacientes con espina bífida congénita alcanzaban la edad adulta y de ellos el 86% tenía una DVP. La ERC de estos pacientes se relacionó con las pielonefritis crónicas y recurrentes por disfunción vesical 5,6 .…”

Characteristics and Survival of Patients with End Stage Renal Disease and Spina Bifida in the United States Renal Data System

“…5 Previous studies in patients with ESRD who had SB were limited and often restricted to single center investigations, and they primarily focused on renal transplantation 6–11 rather than on dialysis. 12,13 To our knowledge there has been no population based examination of patients with ESRD and SB in the United States.…”