Surgical outcomes analysis of pediatric peritoneal dialysis catheter function in a rural region

• Published in: Journal of pediatric surgery 2013-07, Vol.48 (7), p.1520-1527
• Main Authors: Stone, Matthew L, LaPar, Damien J, Barcia, John P, Norwood, Victoria F, Mulloy, Daniel P, McGahren, Eugene D, Rodgers, Bradley M, Kane, Bartholomew J
• Format: Article
• Language: English
• Subjects: Adolescent; Catheterization; Catheters, Indwelling; Child; Child, Preschool; Dialysis; Female; Humans; Infant; Infant, Newborn; Male; Pediatrics; Peritoneal dialysis; Peritoneal Dialysis - instrumentation; Renal failure; Renal Insufficiency - surgery; Renal Insufficiency - therapy; Renal transplantation; Rural Health; Surgery; Surgical Procedures, Operative; Treatment Outcome; Young Adult
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.02.032

Abstract Purpose The purpose of this study was to analyze the experience with peritoneal dialysis (PD) at a high-volume, single center institution that supports a rural population. Methods From 2000 to 2010, 88 children (median age: 1.98 years, [range: 2 days–20.2 years]) received 134 PD catheters for the management of acute and chronic renal failure. The primary outcome of interest was the incidence of primary PD catheter failure (replacement or revision within 60 days). Operative technique, longitudinal outcomes, and time intervals to transplantation were analyzed. Results Median time to transplant from the institution of dialysis was 1.4 years [range: 0.3–6.4 years]. Primary catheter failure occurred in 24.6% of cases. Infants less than 6 months of age demonstrated an increased incidence of primary catheter failure ( p = 0.02). The operative technique for catheter placement was not associated with the incidence of primary failure. Postoperative complications included peritonitis (22.7%), omental plugging (11.9%), pericatheter drainage (9.0%), and exit site infection (3.0%). Conclusion Peritoneal dialysis provides a safe and effective renal replacement therapy for regional pediatric centers that serve a rural population. However, primary catheter failure rates remain high at 24.6%. The surgical technique for placement had no effect on this failure rate in our patient population. Infants less than 6 months of age are at increased risk for primary catheter failure and warrant intensive surveillance.