Risk factors for morbidity and mortality in pediatric patients with peritoneal dialysis catheters

Phan, Jennifer; Stanford, Steve R.; Zaritsky, Joshua J.; DeUgarte, Daniel A.

doi:10.1016/j.jpedsurg.2012.10.035

Cited by 42 publications

(25 citation statements)

References 16 publications

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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: 93%

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: 93%

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

Borzych-Dużałka¹,

Aki²,

Azócar³

et al. 2016

CJASN

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“…Yine bu yöntem ile sorunsuz ve kolayca omentektomi de yapılmaktadır. Bu da kronik periton diyalizinin sık rastlanılan omentum ile tıkan-ma sorununu azaltmaktadır (7,8) . Yine tamamen endoskopik olarak uygulandığından, periton diyalizlerinde sık rastlanılan ve diyaliz için peritonun kullanımını kısıtlayan karıniçi yapışıklık olasılığı da, en azından teorik olarak, azalmaktadır.…”

Section: Discussionunclassified

Insertion of peritoneal dialysis catheter: An easy method through a single port, and its technical details

Tander¹

2016

Tccd

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“…Two smaller studies found decreased catheter occlusion rates in children with omentectomy (4.5 and 19 %) than in those without omentectomy (22.7 and 36 %, respectively), but these did not reach statistical significance [133,134]. A larger study with 207 pediatric patients noted on multivariate analysis that lack of omentectomy was associated with nearly double the reoperative rate for infection or malfunction [135]. An additional review Surg Endosc (2014) 28:3016-3045 3023 of 163 children with PD catheters revealed a significant reduction in catheter failure rate from 23 to 15 % when omentectomy was performed [136].…”

Section: Omentopexy and Omentectomymentioning

confidence: 99%

“…None of these reviews noted any significant decrease in reoperation for catheter dysfunction [68,133,135]. One study included 36 patients with laparoscopic placement and fixation in the pelvis to 23 patients with open catheter placement.…”

Section: Comparative Studies In Pediatricsmentioning

confidence: 99%

“…The incidence of dialysate leak has been noted to be higher (up to 18 %) in infants than larger patients, likely due to their thinner abdominal walls [135]. Rusthoven et al reported the use of fibrin glue to the catheter tunnel exit site in 8 pediatric patients in whom dialysate leaks was seen in the first 24-48 h after catheter insertion.…”

Section: Dialysate Leakmentioning

confidence: 99%

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Guidelines for laparoscopic peritoneal dialysis access surgery

et al. 2014

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Risk factors for morbidity and mortality in pediatric patients with peritoneal dialysis catheters

Cited by 42 publications

References 16 publications

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

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

Insertion of peritoneal dialysis catheter: An easy method through a single port, and its technical details

Guidelines for laparoscopic peritoneal dialysis access surgery

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