ABSTRACT
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.
Subject(s)
Acute Kidney Injury , Escherichia coli Infections , Hemolytic-Uremic Syndrome , Peritoneal Dialysis , Shiga-Toxigenic Escherichia coli , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Acute Kidney Injury/therapy , Child , Escherichia coli Infections/complications , Escherichia coli Infections/epidemiology , Escherichia coli Infections/therapy , Hemolytic-Uremic Syndrome/complications , Hemolytic-Uremic Syndrome/epidemiology , Hemolytic-Uremic Syndrome/therapy , Humans , Peritoneal Dialysis/adverse effects , Peritonitis/epidemiology , Peritonitis/etiology , Retrospective StudiesABSTRACT
BACKGROUND: This study aimed to evaluate mechanical and infectious complications associated with urgent-start peritoneal dialysis (PD) and patients and technique survival in the first 180 days. METHODS: It was a prospective study that evaluated chronic patients who started unplanned PD using high-volume PD (HVPD) right after (<72 h) PD catheter placement. After hospital discharge, patients were treated with intermittent PD on alternate days in a dialysis unit until family training was provided. RESULTS: Fifty-one patients fulfilling the following criteria were included: age was 62.1 ± 15 years, with diabetes as the main etiology of end-stage renal disease (39%), and uremia as the main dialysis indication (76%). Metabolic and fluid controls were achieved after 3 sessions of HVPD, and patients remained in intermittent PD for 23.2 ± 7.2 days. Mechanical complications occurred in 25.7% and peritonitis rate was 0.5 episode/patient-year. In the first 6 months, technique and patients survival rates were 86 and 82.4% respectively. CONCLUSION: The PD modality was a feasible and safe alternative to hemodialysis in the urgent-start dialysis.
Subject(s)
Diabetes Complications , Kidney Failure, Chronic , Peritoneal Dialysis , Aged , Brazil/epidemiology , Diabetes Complications/mortality , Diabetes Complications/therapy , Disease-Free Survival , Female , Follow-Up Studies , Humans , Kidney Failure, Chronic/mortality , Kidney Failure, Chronic/therapy , Male , Middle Aged , Survival RateABSTRACT
Introducción: La diálisis peritoneal aguda (DPA) es la modalidad dialítica preferentemente seleccionada para niños con injuria renal aguda por síndrome urémico hemolítico postdiarreico (SUH D+). Evaluamos la seguridad y eficacia de la colocación por punción percutánea del catéter de DPA con anestesia local en niños con SUH D+. Pacientes y métodos: Se revisaron las historias clínicas de todos los pacientes con SUH D+ internados entre el 1 de enero de 1998 y el 31 de diciembre de 2008 en el Hospital de Pediatría Prof. Dr. Juan P. Garrahan. La seguridad se evaluó por la presencia de eventos adversos mayores relacionados con la colocación del catéter (per foración de vísceras y/o vasos mayores abdominales, sangrado que requiera transfusión) y menores (infección del sitio de salida y peritonitis dentro de las 48 hs del procedimiento). La eficacia se evaluó a través de la colocación exitosa del catéter y su buen funcionamiento. Además se registró la necesidad de recambio luego de su uso por mal funcionamiento. Resultados: Identificamos 149 pacientes que realizaron DPA, edad de 20.2 meses (rango 2,9-111) y peso de 11,35 kg (rango 5-24.4). Recuento de plaquetas previo al procedimiento de 89000 (22000-148000) mm3. Seguridad: el único efecto adverso detectado fue el desarrollo de peritonitis en un paciente. No se registró perforación de órganos ni de vasos mayores abdominales, ni sangrado severo, ni infección del sitio de salida. Eficacia: en todos los casos el catéter fue colocado exitosamente y en 48 pacientes (32.2%) hubo que recambiarlo por mal funcionamiento. Tanto la colocación como el recambio fueron realizadas en todos los casos por el nefrólogo al pie de la cama. Conclusión: la colocación del catéter de DPA por punción es un procedimiento seguro y eficaz.
ntroduction: Acute peritoneal dialysis (DPA) is the dialytictreatment of choice for children with acute kidney injury dueto post-diarrheal hemolytic uremic syndrome (D+HUS). In thisstudy safety and efficacy of percutaneous placement of anAPD catheter under local anesthesia in children with D+HUSwas assessed. Patients and methods: We reviewed the cli-nical charts of all patients with D+HUS admitted to thePediatric Hospital Prof. Dr. Juan P. Garrahan betweenJanuary 1, 1998 and December 31, 2008. Safety was eva-luated based on the presence of major (perforation of theviscera and/or major abdominal vessels, bloody dialysaterequiring red-blood-cell transfusion) and minor (exit-siteinfection and peritonitis within 48 hs of the procedure) adverse events associated with catheter insertion. Efficacy was assessed based on successful catheter insertion and func-tioning. Additionally, the need for catheter replacement dueto malfunction was recorded. Results: We identified 149patients with a mean age of 20.2 months (range, 2.9-111)and weight of 11.35 kg (range, 5-24.4) who underwent APD.Median platelet count previous to the procedure was 89000(range, 22000-148000) mm3. Safety: The only adverse eventfound was the development of peritonitis in one patient.Organ or major vessel perforation, severe bleeds, or exit-site infection were not observed. Efficacy: In all patients the catheter was successfully inserted and in 48 patients (32.2%) the catheter had to be replaced due to malfunctioning. Both placement and replacement were performed by a nephrologist at the bedside in all cases. Conclusion: Percutaneous APD catheter insertion is a safe and efficacious procedure.