Acute peritoneal dialysis, complications and outcomes in 389 children with STEC-HUS: a multicenter experience

• Published in: Pediatric nephrology (Berlin, West) West), 2021-06, Vol.36 (6), p.1597-1606
• Main Authors: Coccia, Paula A., Ramírez, Flavia B., Suárez, Angela D. C., Alconcher, Laura F., Balestracci, Alejandro, García Chervo, Laura A., Principi, Iliana, Vázquez, Aída, Ratto, Viviana M., Planells, María Celia, Montero, Jorge, Saurit, Mariana, Gutiérrez, Maria Graciela Pérez Y, Puga, María Celeste, Isern, Elsa M., Bettendorff, María Carolina, Boscardin, Marcela V., Bazán, Marta, Polischuk, Mario A., De Sarrasqueta, Alejo, Aralde, Adriana, Ripeau, Diego B., Leroy, Daniela C., Quijada, Nahir E., Escalante, Romina S., Giordano, Marta I., Sánchez, Cristian, Selva, Verónica S., Caminiti, Alejandra, Ojeda, José María, Bonany, Pablo, Morales, Sandra E., Allende, Daniel, Arias, María Andrea, Exeni, Andrea M., Geuna, Jésica D., Arrúa, Larisa
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - epidemiology; Acute Kidney Injury - etiology; Acute Kidney Injury - therapy; Acute renal failure; Antibiotics; Care and treatment; Catheters; Child; Children; Complications and side effects; Continuous ambulatory peritoneal dialysis; Escherichia coli infections; Escherichia coli Infections - complications; Escherichia coli Infections - epidemiology; Escherichia coli Infections - therapy; Hemolytic uremic syndrome; Hemolytic-Uremic Syndrome - complications; Hemolytic-Uremic Syndrome - epidemiology; Hemolytic-Uremic Syndrome - therapy; Humans; Hyperglycemia; Kidneys; Medical records; Medicine; Medicine & Public Health; Multivariate analysis; Nephrology; Neurological complications; Original Article; Patient outcomes; Patients; Pediatric research; Pediatrics; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Peritoneum; Peritonitis; Peritonitis - epidemiology; Peritonitis - etiology; Prophylaxis; Retrospective Studies; Shiga toxin; Shiga-Toxigenic Escherichia coli; Surgery; Urology; What's New in Dialysis
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-020-04876-x

Background Management of acute kidney injury (AKI) in children with hemolytic uremic syndrome induced by a Shiga toxin-producing Escherichia coli infection (STEC-HUS) is supportive; however, 40 to 60% of cases need kidney replacement therapy (KRT). The aim of this study was to analyze procedure complications, especially peritonitis, and clinical outcomes in children with AKI secondary to STEC-HUS treated with acute PD. Methods This is a multicenter retrospective study conducted among thirty-seven Argentinian centers. We reviewed medical records of 389 children with STEC-HUS hospitalized between January 2015 and February 2019 that required PD. Results Complications associated with PD were catheter malfunction ( n = 93, 24%), peritonitis ( n = 75, 19%), fluid leaks ( n = 45, 11.5%), bleeding events ( n = 23, 6%), and hyperglycemia ( n = 8, 2%). In the multivariate analysis, the use of antibiotic prophylaxis was independently associated with a decreased risk of peritonitis (hazard ratio 0.49, IC 95% 0.29–0.81; p = 0.001), and open-surgery catheter insertion was independently associated with a higher risk (hazard ratio 2.8, IC 95% 1.21–6.82; p = 0.001). Discontinuation of PD due to peritonitis, severe leak, or mechanical complications occurred in 3.8% of patients. No patient needed to be transitioned to other modality of KRT due to inefficacy of the technique. Mortality during the acute phase occurred in 2.8% patients due to extrarenal complications (neurological and cardiac involvement), not related to PD. Conclusions Acute PD was a safe and effective method to manage AKI in children with STEC-HUS. Prophylactic antibiotics prior to insertion of the PD catheter should be considered to decrease the incidence of peritonitis.