SpringerLink
Log in

Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Maintenance peritoneal dialysis (PD) is the dialysis modality of choice for infants and young children. However, there are limited outcome data for those who undergo PD catheter insertion and initiate maintenance PD within the first year of life.

Methods

Using data from the Children’s Hospital Association’s Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (ESRD) Collaborative (SCOPE), we examined peritonitis rates and patient survival in 156 infants from 29 North American pediatric dialysis centers who had a chronic PD catheter placed prior to their first birthday.

Results

In-hospital and overall annualized rates of peritonitis were 1.73 and 0.76 episodes per patient-year, respectively. Polycystic kidney disease was the most frequent renal diagnosis and pulmonary hypoplasia the most common co-morbidity in infants with peritonitis. Multivariable regression models demonstrated that nephrectomy at or prior to PD catheter placement and G-tube insertion after catheter placement were associated with a nearly sixfold and nearly threefold increased risk of peritonitis, respectively. Infants with peritonitis had longer initial hospital stays and lower overall survival (86.3 vs. 95.6%, respectively; P < 0.02) than those without an episode of peritonitis.

Conclusions

In this large cohort of infants with ESRD, the frequency of peritonitis was high and several risk factors associated with the development of peritonitis were identified. Given that peritonitis was associated with a longer duration of initial hospitalization and increased mortality, increased attention to the potentially modifiable risk factors for infection is needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Carey WA, Martz KL, Warady BA (2015) Outcome of patients initiating chronic peritoneal dialysis during the first year of life. Pediatrics 136(3):e615–22

  2. Lantos JD, Warady BA (2013) The evolving ethics of infant dialysis. Pediatr Nephrol 28:1943–1947

    Article  PubMed  Google Scholar 

  3. Rees L (2007) Long-term peritoneal dialysis in infants. Perit Dial Int 27[Suppl 2]:S180–S184

    PubMed  Google Scholar 

  4. Carey WA, Talley LI, Sehring SA, Jaskula JM, Mathias RS (2007) Outcomes of dialysis initiated during the neonatal period for treatment of end-stage renal disease: a north American pediatric renal trials and collaborative studies special analysis. Pediatrics 119:e468–e473

    Article  PubMed  Google Scholar 

  5. van Stralen KJ, Borzych-Duzalka D, Hataya H, Kennedy SE, Jager KJ, Verrina E, Inward C, Ronnholm K, Vondrak K, Warady BA, Zurowska AM, Schaefer F, Cochat P (2014) Survival and clinical outcomes of children starting renal replacement therapy in the neonatal period. Kidney Int 86:168–174

    Article  PubMed  Google Scholar 

  6. Vidal E, Edefonti A, Murer L, Gianoglio B, Maringhini S, Pecoraro C, Sorino P, Leozappa G, Lavoratti G, Ratsch IM, Chimenz R, Verrina E (2012) Peritoneal dialysis in infants: the experience of the Italian registry of paediatric chronic dialysis. Nephrol Dial Transplant 27:388–395

    Article  PubMed  Google Scholar 

  7. Borzych-Duzalka D, Aki TF, Azocar M, White C, Harvey E, Mir S, Adragna M, Serdaroglu E, Sinha R, Samaille C, Vanegas JJ, Kari J, Barbosa L, Bagga A, Galanti M, Yavascan O, Leozappa G, Szczepanska M, Vondrak K, Tse KC, Schaefer F, Warady BA (2016) Peritoneal dialysis access revision in children: causes, interventions, and outcomes. Clin J Am Soc Nephrol 12:105–112

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vidal E, van Stralen KJ, Chesnaye NC, Bonthuis M, Holmberg C, Zurowska A, Trivelli A, Da Silva JE, Herthelius M, Adams B, Bjerre A, Jankauskiene A, Miteva P, Emirova K, Bayazit AK, Mache CJ, Sanchez-Moreno A, Harambat J, Groothoff JW, Jager KJ, Schaefer F, Verrina E (2016) Infants requiring maintenance dialysis: outcomes of hemodialysis and peritoneal dialysis. Am J Kidney Dis 69(5):617–625

  9. Neu AM, Miller MR, Stuart J, Lawlor J, Richardson T, Martz K, Rosenberg C, Newland J, McAfee N, Begin B, Warady BA (2014) Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative. Pediatr Nephrol 29:1477–1484

    Article  PubMed  Google Scholar 

  10. Neu AM, Richardson T, Lawlor J, Stuart J, Newland J, McAfee N, Warady BA (2016) Implementation of standardized follow-up care significantly reduces peritonitis in children on chronic peritoneal dialysis. Kidney Int 89:1346–1354

    Article  PubMed  Google Scholar 

  11. Warady BA, Bakkaloglu S, Newland J, Cantwell M, Verrina E, Neu AM, Chadha V, Yap H, Schaefer F (2012) Consenus guidelines for the prevention and treatment of catheter-related infections and peritonitis in pediatric patients Receiveing peritoneal dialysis: 2012 update. Perit Dial Int 32:S32–S86

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Carpenter JL, Fallon SC, Swartz SJ, Minifee PK, Cass DL, Nuchtern JG, Pimpalwar AP, Brandt ML (2016) Outcomes after peritoneal dialysis catheter placement. J Pediatr Surg 51:730–733

    Article  PubMed  Google Scholar 

  13. Sethna CB, Bryant K, Munshi R, Warady BA, Richardson T, Lawlor J, Newland JG, Neu A (2016) Risk factors for and outcomes of catheter-associated peritonitis in children: the SCOPE collaborative. Clin J Am Soc Nephrol 11:1590–1596

    Article  PubMed  PubMed Central  Google Scholar 

  14. North American Pediatric Renal Trials andCollaborative Studies (2011) NAPRTCS annual dialysis report. https://web.emmes.com/study/ped/annlrept/annlrept.html

  15. Murugasu B, Conley SB, Lemire JM, Portman RJ (1991) Fungal peritonitis in children treated with peritoneal dialysis and gastrostomy feeding. Pediatr Nephrol 5:620–621

    Article  CAS  PubMed  Google Scholar 

  16. von Schnakenburg C, Feneberg R, Plank C, Zimmering M, Arbeiter K, Bald M, Fehrenbach H, Griebel M, Licht C, Konrad M, Timmermann K, Kemper MJ (2006) Percutaneous endoscopic gastrostomy in children on peritoneal dialysis. Perit Dial Int 26:69–77

    Google Scholar 

  17. Guay-Woodford LM, Desmond RA (2003) Autosomal recessive polycystic kidney disease: the clinical experience in North America. Pediatrics 111:1072–1080

    Article  PubMed  Google Scholar 

  18. Beaunoyer M, Snehal M, Li L, Concepcion W, Salvatierra O Jr, Sarwal M (2007) Optimizing outcomes for neonatal ARPKD. Pediatr Transplant 11:267–271

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The following centers/team Leaders participated in the SCOPE Collaborative during the first 3 years:

AI DuPont Hospital for Children: Joshua Zaristky, Susan Kieffner; American Family Children’s Hospital: Allison Redpath Mahon, Dawn Foster; Lurie Children’s Hospital of Chicago: Mahima Keswani, Nancy Majkowski; Arkansas Children’s Hospital: Richard Blaszak, Christine Blaszak; Boston Children’s Hospital: Michael Somers, Theresa Pak; Children’s Hospital New Orleans: Diego Aviles, Evie Jenkins; Children’s Hospital Los Angeles: Rachel Lestz, Alice Sanchez; Children’s Hospital of Wisconsin: Cynthia Pan, Jackie Dake; Children’s Medical Center Dallas, Raymond Quigley, Haridas Thankappan; Children’s Mercy Hospital: Bradley Warady, JoLyn Grimes; Children’s National Medical Center: Kirtida Mistry, Jennifer Carver; Cincinnati Children’s Hospital Medical Center: Rene Van De Voorde, Ellen Irvin; Driscoll Children’s Hospital: Samhar Al-Akash, Britt Stone; Maynard Children’s Hospital at Vidant Medical Center: Guillermo Hidalgo, Malinda Harrington; Johns Hopkins Children’s Center: Alicia Neu, Barbara Case; Kosair Children’s Hospital: Sushil Gupta, Andrea Baker; Levine Children’s Hospital: Jack Weaver, Annabelle Chua; Lucile Packard Children’s Hospital at Stanford: Cynthia Wong, Brandy Begin; Mattel Children’s Hospital UCLA: Isidro Salusky, Barbara Gales; Nationwide Children’s Hospital: Hiren Patel, Beth Smith; Phoenix Children’s Hospital: Mark Joseph, Deb Haskins; Rainbow Babies Hospital: David Kenagy, Beth Vogt; Seattle Children’s Hospital: Coral Hanevold, Nancy McAfee; St. Louis Children’s Hospital: Ann Beck, Meg Shea; Cohen Children’s Medical Center of New York: Christine Sethna, Myung Cho; Texas Children’s Hospital: Sarah Scwartz, Helen Currier; The Children’s Hospital at Montefiore: Amy Skversky, Maureen Eisele; The Children’s Hospital of Philadelphia: Madhura Pradhan, Christine Breen; UCSF Benioff Children’s Hospital: Paul Brakeman, Lina Campopiano; University of Iowa Children’s Hospital: Jennifer Jetton, Jennifer Ehrlich; Upstate Golisano Children’s Hospital: Lawrence Shoemaker, Nancy Zacharek.

Author information

Authors and Affiliations

  1. Nemours, A.I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA

    Joshua Jacob Zaritsky

  2. Seattle Children’s Hospital, Seattle, WA, USA

    Coral Hanevold

  3. Children’s Medical Center, Dallas, TX, USA

    Raymond Quigley

  4. Children’s Hospital Association, Lenexa, KS, USA

    Troy Richardson, John Lawlor & Jonathan Rodean

  5. Lucille Packard Hospital for Children, Stanford, CA, USA

    Cynthia Wong

  6. Stead Family Children’s Hospital, Iowa City, IA, USA

    Jennifer Ehrlich

  7. Johns Hopkins Children’s Center, Baltimore, MD, USA

    Alicia Neu

  8. Children’s Mercy Kansas City, Kansas City, MO, USA

    Bradley A. Warady

Authors
  1. Joshua Jacob Zaritsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Coral Hanevold
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raymond Quigley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Troy Richardson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cynthia Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jennifer Ehrlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John Lawlor
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jonathan Rodean
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alicia Neu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bradley A. Warady
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the SCOPE Investigators

Corresponding author

Correspondence to Joshua Jacob Zaritsky.

Ethics declarations

The Declaration of Helsinki was followed and the collaborative protocol was approved by the Institutional Review Board at each participating center. Consent was obtained for all subjects enrolled when required by the Institutional Review Board at each participating center.

Conflict of interest

We declare that the results presented in this paper have not been published previously in whole or part, except in abstract format.

Additional information

See Acknowledgements for a full list of the centers/team leaders participating in the SCOPE Collaborative during the first 3 years.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zaritsky, J.J., Hanevold, C., Quigley, R. et al. Epidemiology of peritonitis following maintenance peritoneal dialysis catheter placement during infancy: a report of the SCOPE collaborative. Pediatr Nephrol 33, 713–722 (2018). https://doi.org/10.1007/s00467-017-3839-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-017-3839-5

Keywords

Search

Navigation