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Risk factors for early onset peritonitis: the SCOPE collaborative

  • Mahima KeswaniEmail author
  • Allison C. Redpath Mahon
  • Troy Richardson
  • Jonathan Rodean
  • Olivera Couloures
  • Abigail Martin
  • Richard T. Blaszak
  • Bradley A. Warady
  • Alicia Neu
  • on behalf of the SCOPE Investigators
Original Article

Abstract

Background

Peritoneal dialysis (PD) is the preferred chronic dialysis modality amongst pediatric patients. Peritonitis is a devastating complication of PD. Adult data demonstrates early onset peritonitis (EP) is associated with higher rates of subsequent peritonitis and technique failure. Limited data exists regarding EP in the pediatric population, here defined as peritonitis occurring within 60 days of catheter insertion.

Methods

PD catheter insertion practices and EP episodes were examined from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) collaborative database.

Results

There were 98 episodes of EP amongst 1106 PD catheters inserted. Multivariable analysis demonstrated a significant association between early use of the PD catheter and EP (P = 0.001). Age less than 1 year at the time of catheter insertion (P < 0.001), first catheter placed (P < 0.001) for the patient, use of a plastic adapter (P = 0.003), placement of sutures at the exit site (ES) (P = 0.032), and dressing change prior to 7 days post-operatively (P < 0.001) were all significantly associated with early PD catheter use. Concurrent placement of a hemodialysis catheter was associated with a decreased risk for early PD catheter use (P = 0.010).

Conclusions

In this large cohort of pediatric PD recipients, 8.4% of PD catheters were associated with the development of EP. The finding of an association between early use of the PD catheter and EP represents a potentially modifiable risk factor to reduce infection rates within this patient population.

Keywords

Early onset peritonitis Pediatric Peritoneal Dialysis 

Notes

Acknowledgements

Participating Centers Contributing Data to the SCOPE Collaborative:

Akron Children’s Hospital, OH

American Family Children’s Hospital, WI

Ann & Robert H. Lurie Children’s Hospital of Chicago, IL

Arkansas Children’s Hospital, AR

Arnold Palmer Hospital for Children, FL

Boston Children’s Hospital, MA

Children’s Health, Dallas, TX

Children’s of Alabama, AL

Children’s Hospital Colorado, CO

Children’s Hospital Los Angeles, CA

Children’s Hospital of Wisconsin, WI

Children’s Mercy Kansas City, MO

Children’s National Health System, DC

Cincinnati Children’s Hospital Medical Center, OH

Cleveland Clinic Children’s, OH

Cohen Children’s Medical Center, NY

Connecticut Children’s Medical Center, CT

Cook Children’s Medical Center, TX

Dell Children’s Medical Center of Central Texas, TX

Doernbecher Children’s Hospital at Oregon Health & Science University, OR

Driscoll Children’s Hospital, TX

Golisano Children’s Hospital at the University of Rochester Medical Center, NY

Johns Hopkins Children’s Center, MD

Levine Children’s Hospital, NC

Lucile Packard Children’s Hospital at Stanford, CA

Mattel Children’s Hospital UCLA, CA

MUSC Children’s Hospital, SC

Nationwide Children’s Hospital, OH

Nemours/Alfred I. duPont Hospital for Children, DE

Nicklaus Children’s Hospital, FL

Phoenix Children’s Hospital, AZ

Primary Children’s Hospital, UT

Seattle Children’s Hospital, WA

SSM Cardinal Glennon Children’s Medical Center, MO

St. Louis Children’s Hospital, MO

Texas Children’s Hospital, TX

The Children’s Hospital at Montefiore, NY

The Children’s Hospital at OU Medical Center, OK

The Children’s Hospital of Philadelphia, PA

The Mount Sinai Kravis Children’s Hospital, NY

UCSF Benioff Children’s Hospital San Francisco, CA

University of California, Davis, CA

University of Iowa Stead Family Children’s Hospital, IA

University of Minnesota Masonic Children’s Hospital, MN

UPMC Children’s Hospital of Pittsburgh

Yale-New Haven Children’s Hospital, CT

Compliance with ethical standards

The Declaration of Helsinki was followed and the collaborative protocol was approved by the Institutional Review Board at each participating center. Informed consent was obtained where required by the institution’s Institutional Review Board.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Alexander SR, Warady BA (2004) The demographics of dialysis in children. In: Warady BA, Schaefer FS, Fine RN, Alexander SR (eds) Pediatric dialysis. Kluwer, Dordrecht, pp 35–46CrossRefGoogle Scholar
  2. 2.
    Chadha V, Schaefer FS, Warady BA (2010) Dialysis-associated peritonitis in children. Pediatr Nephrol 25:425–440CrossRefGoogle Scholar
  3. 3.
    The North American Pediatric Renal Trials and Collaborative Studies. NAPRTCS 2011 annual dialysis report (2011)Google Scholar
  4. 4.
    Feng S, Wang Y, Qiu B, Wang Z, Jiang L, Zhan Z, Jiang S, Shen H (2016) Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients. Springerplus. 5(1):167CrossRefGoogle Scholar
  5. 5.
    Harel Z, Wald R, Bell C, Bargman JM (2006) Outcome of patients who develop early-onset peritonitis. Adv Perit Dial 22:46–49Google Scholar
  6. 6.
    Neu AM, Miller MR, Stuart J, Lawlor J, Richardson T, Martz K, Rosenberg C, Newland J, McAfee N, Begin B, Warady BA, Collaborative Participants SCOPE (2014) Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 29:1477–1484CrossRefGoogle Scholar
  7. 7.
    Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu A, ChadhaV YHK, Schaefer F (2012) Consensus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients receiving peritoneal dialysis: 2012 update. Perit Dial Int 32(Suppl 2):S32–S86CrossRefGoogle Scholar
  8. 8.
    See EJ, Johnson DW, Hawley CM, Pascoe EM, Darssan D, Clayton PA, Borlace M, Badve SV, Sud K, Boudville NC, Cho Y (2017) Early peritonitis and its outcome in incident peritoneal dialysis patients. Perit Dial IntGoogle Scholar
  9. 9.
    Tian Y, Xie X, Xiang S, Yang X, Lin J, Zhang X, Shou Z, Chen J (2017) Risk factors and outcomes of early-onset peritonitis in chinese peritoneal dialysis patients. Kidney Blood Press Res 42(6):1266–1276CrossRefGoogle Scholar
  10. 10.
    Wu H, Huang R, Yi C, Wu J, Guo Q, Zhou Q, Yu X, Yang X (2016) Risk factors for early-onset peritonitis in southern Chinese peritoneal dialysis patients. Perit Dial Int 36(6):640–646CrossRefGoogle Scholar
  11. 11.
    Sethna CB, Bryant K, Munshi R, Warady BA, Richardson T, Lawlor J, Newland JG, Neu A (2016) SCOPE investigators: risk factors for and outcomes of catheter-associated peritonitis in children: the SCOPE collaborative. Clin J Am Soc Nephrol 11(9):1590–1596CrossRefGoogle Scholar
  12. 12.
    Patel UD, Mottes TA, Flynn JT (2001) Delayed compared with immediate use of peritoneal catheter in pediatric peritoneal dialysis. Adv Perit Dial 17:253–259Google Scholar
  13. 13.
    Povlsen JV, Ivarsen P (2006) How to start the late referred ESRD patient urgently on chronic APD. Nephrol Dial Transplant 21(Suppl 2):ii56–ii59CrossRefGoogle Scholar
  14. 14.
    Pai MF, Yang JY, Chen HY, Hsu SP, Chiu YL, Wu HY, Tsai WC, Peng YS (2016) Comparing long-term outcomes between early and delayed initiation of peritoneal dialysis following catheter implantation. Ren Fail 38(6):875–881CrossRefGoogle Scholar
  15. 15.
    Zaritsky JJ, Hanevold C, Quigley R, Richardson T, Wong C, Ehrlich J, Lawlor J, Rodean J, Neu A, Warady BA (2017) Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative. Pediatr Nephrol 33(4):713–722CrossRefGoogle Scholar

Copyright information

© IPNA 2019

Authors and Affiliations

  • Mahima Keswani
    • 1
    Email author
  • Allison C. Redpath Mahon
    • 2
  • Troy Richardson
    • 3
  • Jonathan Rodean
    • 3
  • Olivera Couloures
    • 4
  • Abigail Martin
    • 5
  • Richard T. Blaszak
    • 6
  • Bradley A. Warady
    • 7
  • Alicia Neu
    • 8
  • on behalf of the SCOPE Investigators
  1. 1.Ann and Robert H. Lurie Children’s Hospital of ChicagoChicagoUSA
  2. 2.American Family Children’s HospitalMadisonUSA
  3. 3.Children’s Hospital AssociationLenexaUSA
  4. 4.Yale New Haven Children’s HospitalNew HavenUSA
  5. 5.Nemours A.I. duPont Hospital for ChildrenWilmingtonUSA
  6. 6.Arkansas Children’s HospitalLittle RockUSA
  7. 7.Children’s Mercy Kansas CityKansas CityUSA
  8. 8.John’s Hopkins Children’s CenterBaltimoreUSA

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