Peritonitis in children on peritoneal dialysis in Cape Town, South Africa: epidemiology and risks

Abstract

Peritonitis is a frequent complication of peritoneal dialysis (PD) in children as well in adults. Data on PD and peritonitis in pediatric patients are very scarce in developing countries. A retrospective cohort study was performed between 2000 and 2008 with the aim to evaluate PD treatment and peritonitis epidemiology in pediatric patients in South Africa and identify risk factors for peritonitis. Baseline characteristics and potential risk factors of peritonitis were recorded, including housing, socio-economic circumstances, distance to PD center, type of PD, mode of catheter placement, race, presence of gastrostomy tube, weight, and height. Outcome indices for peritonitis were peritonitis rate, time to first peritonitis, and number of peritonitis-free patients. The patient cohort comprised 67 patients who were on PD for a total of 544 months. The total number of peritonitis episodes was 129. Median peritonitis rate was one episode every 4.3 patient months (2.8 episodes/patient-year, range 0–21.2). Median time to first infection was 2.03 months (range 0.1–21.5 months), and 28.4% of patients remained free from peritonitis. Patients with good housing and good socio-economic circumstances had a significantly lower peritonitis rate and a longer time to first peritonitis episode. Peritonitis rate was high in this cohort, compared to numbers reported for the developed world; the characteristics of causative organisms are comparable. The most important risk factors for the development of peritonitis were poor housing and poor socio-economic circumstances. More intensive counseling may be beneficial, but improvement of general socio-economic circumstances will have the greatest influence on PD success.

Risk Factors for Peritonitis in a Pediatric Dialysis Program in Guatemala, 2011–2014

“…Additionally, the peritonitis rate of our program was comparable to reports from treatment centers in the developed world that have a longer history of providing PD [5]. Also, the population that remained peritonitis-free at FUNDANIER was similar to what has been reported in Vienna where 43% patients were free of peritonitis [5] and in South Africa with 28.5% patients peritonitis-free [7]. We perceive that undiagnosed cases are the result of patients arriving to clinic in the late stages of ESRD.…”

“…FUNDANIER is a relatively new pediatric nephrology program serving most of the Guatemalan pediatric population with ESRD. Although FUNDANIER is a relatively new program, the cohort being treated here had a longer PD treatment time (1855 patientmonths) compared to other programs with treatment periods from 578 and 544 patient-months [3,7]. Additionally, the peritonitis rate of our program was comparable to reports from treatment centers in the developed world that have a longer history of providing PD [5].…”

“…Peritonitis is the most common complication of PD in children and adults [7]. The reported annual rate of peritonitis in children using PD is 0.77-2.8 episodes per patient-year or one episode of peritonitis every 4.3-18 patient-months [3,[7][8][9] having both short and long term impacts [1,3,8]. Peritonitis is the primary cause of catheter loss and withdrawal from dialysis treatment [10].…”

“…Peritonitis also presents a mortality risk of at least 1% and is the leading cause of death in children and adults on chronic PD [8,11,12]. It also presents a risk in low income countries where infection is more prevalent due to lower socioeconomic status and housing levels [7].…”

“…Socioeconomic circumstances have shown having the greatest related risk factors on the development of peritonitis [3,5,7]. Outcomes of patients treated with PD improve by identifying risk factors and implementing specific preventive measures to overcome PD in this setting [13].…”