A ten-year single-centre experience in children on chronic peritoneal dialysis--significance of percutaneous placement of peritoneal dialysis catheters.

BACKGROUND: Chronic peritoneal dialysis (CPD) in children is an important modality of renal replacement therapy. The ideal method for inserting CPD catheters remains still controversial. Minimal invasive techniques are becoming more popular. This study was performed in order to evaluate the efficiency, the complication profile and the survey of percutaneously placed CPD catheters in children, retrospectively.
METHODS: This study was carried out on 108 peritoneal catheters implanted in 93 patients (45 girls, 48 boys), aged 8.0+/-4.2 years (range: 3 months to 16 years) during the period between December 1995 and November 2005. In the study group, 32 children were transplanted, 15 were transferred to haemodialysis and 18 patients died. All catheters implanted by percutaneous route were Tenckhoff swan-neck double-cuff paediatric catheters. Placement procedure was performed in our unit by us. Statistical analysis was made by chi-square and Kaplan-Meier methods.
RESULTS: During 2670 CPD months we observed a total of 108 catheter-related complications: 82 catheter infections including exit-site and/or tunnel infection (1/32.5 patient-months), 10 dislocations, six drainage problems and six kinks. The incidence of all complications was one complication every 24.72 dialysis months. Overall, the incidence of peritonitis was one episode per 18.1 patient-months. Pseudomonas spp. and Staphylococcus aureus were the two most common causes of infections. Fifteen catheters were removed due to catheter-related causes: drainage problems (six patients), catheter dislocation (three patients), omental capture (two patients) kink (two patients) and tunnel infection (two patients). The catheter survival rate was 92.4% at 1 year, 83% at 2 years and 63% at 10 years; patient survival in the 93 children was 91% at 1 year, 84% at 2 years and 48% at 10 years. Younger patients were at increased risk of exit-site and tunnel infections (P<0.05) but the difference in catheter survival time between the age groups was not significant (P>0.05). In complications, no statistical difference was observed between early and delayed catheter use groups (P>0.05). We compared the two periods (period 1, December 1995 to November 2000; period 2, December 2000 to November 2005), for complications of CPD. The risk of catheter migration was greater in period 1 than in period 2 (P=0.04).
CONCLUSIONS: The percutaneous technique performed by experienced nephrologists is a reliable, safe and cost-effective method for placement of PD catheters. In our opinion, the skill for CPD catheter placement must be part of the paediatric nephrologist training.