Peritoneal dialysis catheter infections and peritonitis in children: a report of the North American Pediatric Renal Transplant Cooperative Study |
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Authors: | S L Furth Lynn A Donaldson E Kenneth Sullivan Sandra L Watkins |
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Institution: | (1) NAPRTCS Publications Committee, 19 Bradhurst Avenue, Box 10, Hawthorne, NY 10532, USA e-mail: sfurth@jhmi.edu Tel.: +1-914-3450414, Fax: +1-914-3450229, US;(2) Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, TP;(3) EMMES Corporation, Potomac, Maryland, USA, US;(4) Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA, US |
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Abstract: | Peritonitis and catheter-related infections remain the two most-common causes of peritoneal dialysis (PD) treatment failure.
To define the frequency and risks associated with exit site/tunnel infections (ESI/TI), as well as peritonitis, in pediatric
patients on PD, we undertook a retrospective cohort study of patients initiated on PD in the North American Pediatric Renal
Transplant Cooperative Study (NAPRTCS). We examined demographic data and PD catheter characteristics of 1,258 patients, aged
<21 years, initiated on PD from 1992 to 1997. We examined the frequency and complications of ESI/TI occurring within 30 days,
6 months, and 1 year of follow-up. For peritonitis episodes, we examined patient risk factors for peritonitis. Almost 11%
of patients had an ESI/TI at 30 days, 26% between 30 days and 6 months, and 30% between 6 months and 1 year of follow-up.
There was no increased risk of ESI/TI associated with patient age, race, or catheter characteristics. Peritonitis occurred
in dialysis patients at a rate of 1 episode per 13.2 patient months. Proportional hazards regression analysis demonstrated
that black race, single-cuffed catheters, and upward pointing exit sites were independent risk factors for peritonitis in
the pediatric PD population. Patients with ESI/TI had twice the risk of those without these infections of developing peritonitis
or needing access revision, and an almost threefold increased risk of hospitalization for access complications/malfunction.
ESI/TI occurs commonly in pediatric PD patients. These infections cause significant morbidity, through risk of peritonitis,
access revision, and hospitalization for catheter complications. Further study of potentially modifiable risk factors for
ESI/TI in pediatric end-stage renal disease patients is warranted.
Received: 22 November 1999 / Revised: 7 June 2000 / Accepted: 9 June 2000 |
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Keywords: | Peritoneal dialysis Exit site/tunnel infections Peritonitis |
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